Healthcare Provider Details

I. General information

NPI: 1184616054
Provider Name (Legal Business Name): AMERICAN HEALTH LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15303 W 95TH ST
LENEXA KS
66219-1262
US

IV. Provider business mailing address

15303 W 95TH ST
LENEXA KS
66219-1262
US

V. Phone/Fax

Practice location:
  • Phone: 913-492-3634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: GREGORY DENNIS KENT
Title or Position: ADMINISTRATOR
Credential:
Phone: 913-492-3634