MEDICARE: COMPLETE DX LIMITED LIABILITY COMPANY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	293D00000X	Physiological Laboratory
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1144542754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE DX LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	14711 CHANT ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-1109
Country	:	US
Telephone Number	:	210-601-5313
Fax Number	:	210-479-4057

Provider Business Practice Location Address
First Line	:	14711 CHANT ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-1109
Country	:	US
Telephone Number	:	210-601-5313
Fax Number	:	210-479-4057

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL BAKER
Credential	:
Telephone Number	:	210-601-5313

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	05/05/2010

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Directions to “COMPLETE DX LIMITED LIABILITY COMPANY ” Practice Location

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