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General NPI Number Information
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NPI Number | 1972989424
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Entity Type | Organization
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Legal Business Name | ADVANCED LABS OF SW FLORIDA, LLC
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 6120 WINKLER RD SUITE J
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City | FORT MYERS
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State | FL
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Zip | 33919-8125
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Country | US
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Telephone | 239-789-4130
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7131
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City | FORT MYERS
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State | FL
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Zip | 33919-0131
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Country | US
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Telephone | 239-789-4130
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MICHAEL FREY
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Credential | M.D.
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Telephone | 239-789-4130
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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 | 800027766
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License Number State | FL
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