Provider Demographics
NPI:1144364399
Name:SOUTH MEDICAL LABORATORY CORP.
Entity type:Organization
Organization Name:SOUTH MEDICAL LABORATORY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:MONTADAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-854-0431
Mailing Address - Street 1:1330 CORAL WAY
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2929
Mailing Address - Country:US
Mailing Address - Phone:305-854-0431
Mailing Address - Fax:
Practice Address - Street 1:1330 CORAL WAY
Practice Address - Street 2:SUITE # 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2929
Practice Address - Country:US
Practice Address - Phone:305-854-0431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL-8402Medicare ID - Type UnspecifiedCLINICAL LABORATORY