MEDICARE: AMERICAN LAB, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1073859591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN LAB, LLC

Provider Business Mailing Address
First Line	:	1801 INDIAN RD
Second Line	:	UNIT 103
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 INDIAN RD
Second Line	:	UNIT 103
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4604
Country	:	US
Telephone Number	:	561-662-7400
Fax Number	:

Authorized Official
Title or Position	:	ATTORNEY
Name	:	CRAIG T CUDEN
Credential	:
Telephone Number	:	561-775-7014

Provider Enumeration Date	:	01/02/2013
Last Update Date	:	01/02/2013

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