=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609166495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BH LABS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2011
-----------------------------------------------------
Last Update Date | 04/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 ARTHUR GODFREY RD STE 320
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-962-6465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 960 ARTHUR GODFREY ROAD #320
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-962-6465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/CEO
-----------------------------------------------------
Name | DR. MARK POMPER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-962-6465
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | L10000104729
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------