MEDICARE: D-WAY TO GO LLC

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

General Provider Information

NPI Number	:	1295159499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D-WAY TO GO LLC

Provider Business Mailing Address
First Line	:	3486 ROSTAN LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-2839
Country	:	US
Telephone Number	:	561-577-1243
Fax Number	:

Provider Business Practice Location Address
First Line	:	3486 ROSTAN LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-2839
Country	:	US
Telephone Number	:	561-577-1243
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GREGORY MCCRARY
Credential	:
Telephone Number	:	561-577-1243

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	02/07/2014

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Directions to “D-WAY TO GO LLC ” Practice Location

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