MEDICARE: WP LABORATORIES, 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	:	1316402993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WP LABORATORIES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 76
Second Line	:
City	:	MC COOK
State	:	NE
Zip	:	69001-0076
Country	:	US
Telephone Number	:	308-345-7770
Fax Number	:	308-345-1975

Provider Business Practice Location Address
First Line	:	106 W 3RD ST
Second Line	:
City	:	MC COOK
State	:	NE
Zip	:	69001-3645
Country	:	US
Telephone Number	:	308-345-7770
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. LAURA CLAUSE
Credential	:
Telephone Number	:	308-345-7770

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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