MEDICARE: AMERICAN HOME DIAGNOSTICS 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
2	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1134479793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HOME DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	7575 N CEDAR AVE
Second Line	:	103
City	:	FRESNO
State	:	CA
Zip	:	93720-2693
Country	:	US
Telephone Number	:	559-916-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	7575 N CEDAR AVE
Second Line	:	103
City	:	FRESNO
State	:	CA
Zip	:	93720-2693
Country	:	US
Telephone Number	:	559-916-4433
Fax Number	:

Authorized Official
Title or Position	:	SOLE MBR
Name	:	JANET G BAILEY
Credential	:
Telephone Number	:	559-916-4433

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	09/17/2014

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