MEDICARE: FRIGATE LABORATORY 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	:	1316646201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIGATE LABORATORY LLC

Provider Business Mailing Address
First Line	:	5221 NW 33RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6302
Country	:	US
Telephone Number	:	954-546-1111
Fax Number	:	954-546-2222

Provider Business Practice Location Address
First Line	:	5221 NW 33RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6302
Country	:	US
Telephone Number	:	954-546-1111
Fax Number	:	954-546-2222

Authorized Official
Title or Position	:	OWNER
Name	:	TONY NICHOLS
Credential	:
Telephone Number	:	419-303-6584

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	06/06/2024

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