Provider Demographics
NPI:1700158276
Name:APEX CLINICAL LABORATORIES, INC.
Entity Type:Organization
Organization Name:APEX CLINICAL LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:HEAPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-405-7810
Mailing Address - Street 1:3343 S ATLANTIC AVE
Mailing Address - Street 2:UNIT 202
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-6381
Mailing Address - Country:US
Mailing Address - Phone:386-405-7810
Mailing Address - Fax:
Practice Address - Street 1:933 BEVILLE RD
Practice Address - Street 2:SUITE 101-G
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1755
Practice Address - Country:US
Practice Address - Phone:386-405-7810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory