MEDICARE: AMERICAN METABOLIC TESTING LABORATORIES

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	800010873	FL

General Provider Information

NPI Number	:	1336418698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN METABOLIC TESTING LABORATORIES

Provider Business Mailing Address
First Line	:	1818 SHERIDAN ST
Second Line	:	#102
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-2113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 SHERIDAN ST
Second Line	:	#102
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-2113
Country	:	US
Telephone Number	:	954-929-4814
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	L. M. NEEDHAM
Credential	:
Telephone Number	:	954-929-4814

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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