Provider Demographics
NPI:1700141439
Name:ADVANCED MEDICAL LABORATORIES INC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-338-5355
Mailing Address - Street 1:1690 US HIGHWAY 1 SOUTH
Mailing Address - Street 2:SUITE D
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-6024
Mailing Address - Country:US
Mailing Address - Phone:386-338-5355
Mailing Address - Fax:
Practice Address - Street 1:1690 US HIGHWAY 1 SOUTH
Practice Address - Street 2:SUITE D
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6024
Practice Address - Country:US
Practice Address - Phone:386-338-5355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory