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General NPI Number Information
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NPI Number | 1013283365
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Entity Type | Organization
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Legal Business Name | MED LAB SERVICES, LLC
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 3855 E SILVER SPRINGS BLVD SUITE 105
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City | OCALA
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State | FL
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Zip | 34470-4929
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Country | US
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Telephone | 352-789-6810
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Fax | 352-789-6820
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Provider Business Mailing Address
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Address Line | 3855 E SILVER SPRINGS BLVD SUITE 105
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City | OCALA
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State | FL
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Zip | 34470-4929
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Country | US
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Telephone | 352-789-6810
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Fax | 352-789-6820
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. ROBERT BRADLEY ANDERSON
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Credential |
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Telephone | 352-789-6810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | A41977
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License Number State | FL
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