MEDICARE: AMERICA LABORATORY SERVICE CORP.

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		FL

General Provider Information

NPI Number	:	1609881572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICA LABORATORY SERVICE CORP.

Provider Business Mailing Address
First Line	:	3412 W 84TH ST
Second Line	:	SUITE # E 106
City	:	HIALEAH
State	:	FL
Zip	:	33018-4918
Country	:	US
Telephone Number	:	305-231-8616
Fax Number	:	305-231-8879

Provider Business Practice Location Address
First Line	:	3412 W 84TH ST
Second Line	:	SUITE # E 106
City	:	HIALEAH
State	:	FL
Zip	:	33018-4918
Country	:	US
Telephone Number	:	305-231-8616
Fax Number	:	305-231-8879

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JORGE MANUEL VALLEJO
Credential	:
Telephone Number	:	305-231-8616

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	08/22/2020

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