Organization
AMERICAN MEDICAL LAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMON ITAMAN (ADMINISTRATOR)
(832) 677-8401
Entity
Organization
Contact information
Practice address
755 S 11TH ST, SUITE 255, BEAUMONT, TX 77701-3732
(409) 356-6008
(409) 833-1909
Mailing address
755 S 11TH ST, SUITE 255, BEAUMONT, TX 77701-3732
(409) 356-6008
(409) 833-1909
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D2057150
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2057150
CLIA
TX
Enumeration date
08/27/2014
Last updated
11/14/2014
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