Provider Demographics
NPI:1609881572
Name:AMERICA LABORATORY SERVICE CORP.
Entity Type:Organization
Organization Name:AMERICA LABORATORY SERVICE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:VALLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-231-8616
Mailing Address - Street 1:3412 W 84TH ST
Mailing Address - Street 2:SUITE # E 106
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4918
Mailing Address - Country:US
Mailing Address - Phone:305-231-8616
Mailing Address - Fax:305-231-8879
Practice Address - Street 1:3412 W 84TH ST
Practice Address - Street 2:SUITE # E 106
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4918
Practice Address - Country:US
Practice Address - Phone:305-231-8616
Practice Address - Fax:305-231-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE 9138Medicare ID - Type UnspecifiedCLINICAL LABORATORY