=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346793460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL AMERICAN LABS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2016
-----------------------------------------------------
Last Update Date | 07/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 GREEN RD SUITE A-2
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-1074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-220-5017
-----------------------------------------------------
Fax | 561-576-0632
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1701 GREEN RD SUITE A-2
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-1074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-220-5017
-----------------------------------------------------
Fax | 561-576-0632
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS ASSOCIATE
-----------------------------------------------------
Name | KEITH GILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-576-0624
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 800028201
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------