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General NPI Number Information
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NPI Number | 1790109742
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Entity Type | Organization
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Legal Business Name | FIRST CHOICE LABORATORY LLC
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 6061 NE 14TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-5007
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Country | US
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Telephone | 954-800-1000
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Fax | 954-800-1111
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Provider Business Mailing Address
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Address Line | 6061 NE 14TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-5007
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Country | US
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Telephone | 954-800-1000
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Fax | 954-800-1111
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Authorized Official
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Title or Position | MEMBER
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Name | RUSSELL L KITCHEN
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Credential |
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Telephone | 954-800-1000
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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 | 800027078
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License Number State | FL
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