MEDICARE: RMG ART LABORATORY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	800020271	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10D1035477	OTHER	FL	CLIA
2	L9269	OTHER	FL	BCBS NUMBER

General Provider Information

NPI Number	:	1083609127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RMG ART LABORATORY

Provider Business Mailing Address
First Line	:	5245 E FLETCHER AVE
Second Line	:	SUITE 2
City	:	TAMPA
State	:	FL
Zip	:	33617-1126
Country	:	US
Telephone Number	:	813-914-7304
Fax Number	:	813-914-7314

Provider Business Practice Location Address
First Line	:	5245 E FLETCHER AVE
Second Line	:	SUITE 2
City	:	TAMPA
State	:	FL
Zip	:	33617-1126
Country	:	US
Telephone Number	:	813-914-7304
Fax Number	:	813-914-7314

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MARC A BERNHISEL
Credential	:	M.D.
Telephone Number	:	813-914-7304

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	03/07/2012

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Directions to “RMG ART LABORATORY ” Practice Location

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