Healthcare Provider Details

I. General information

NPI: 1023293644
Provider Name (Legal Business Name): AMERICAN HEALTH LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
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: 913-492-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number6734
License Number StateKS

VIII. Authorized Official

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