MEDICARE: EM1 LABS, 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	10D2079549	FL
2	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346641875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EM1 LABS, LLC

Provider Business Mailing Address
First Line	:	3115 NW 10TH TER STE 108
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-5937
Country	:	US
Telephone Number	:	561-223-3269
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 NW 10TH TER STE 108
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-5937
Country	:	US
Telephone Number	:	561-223-3269
Fax Number	:

Authorized Official
Title or Position	:	OWNER (CFO)
Name	:	ANGELO SKULAS
Credential	:
Telephone Number	:	954-380-8488

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	06/16/2018

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