Organization
AMS MEDICAL LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN A CAMILLO (OWNER)
(314) 200-6450
Entity
Organization
Contact information
Practice address
2900 LEMAY FERRY RD, SUITE 205, SAINT LOUIS, MO 63125-3900
(314) 200-6450
(314) 200-6451
Mailing address
2900 LEMAY FERRY RD, SUITE 205, SAINT LOUIS, MO 63125-3900
(314) 200-6450
(314) 200-6451
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
26D2045157
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26D2045157
CLIA
MO
Enumeration date
02/25/2016
Last updated
02/25/2016
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