Organization
MEDICAL ARTS LABORATORY OF NEW SMYRNA BEACH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS GLENN BENTLEY I MT (OWNER PRESIDENT)
(386) 428-5745
Entity
Organization
Contact information
Practice address
257 N CAUSEWAY, NEW SMYRNA BEACH, FL 32169-5239
(386) 428-5745
(386) 427-6566
Mailing address
257 N CAUSEWAY, NEW SMYRNA BEACH, FL 32169-5239
(386) 428-5745
(386) 427-6566
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800000003
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D0645062
CLIA
FL
Enumeration date
05/08/2007
Last updated
01/06/2014
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