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General NPI Number Information
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NPI Number | 1336418698
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Entity Type | Organization
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Legal Business Name | AMERICAN METABOLIC TESTING LABORATORIES
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 1818 SHERIDAN ST #102
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City | HOLLYWOOD
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State | FL
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Zip | 33020-2113
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Country | US
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Telephone | 954-929-4814
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Fax |
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Provider Business Mailing Address
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Address Line | 1818 SHERIDAN ST #102
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City | HOLLYWOOD
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State | FL
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Zip | 33020-2113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | L. M. NEEDHAM
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Credential |
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Telephone | 954-929-4814
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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 | 800010873
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License Number State | FL
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