MEDICARE: LINDALE MEDICAL 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		TX

General Provider Information

NPI Number	:	1376678904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDALE MEDICAL LABORATORY

Provider Business Mailing Address
First Line	:	500 PAREDES LINE RD
Second Line	:	SUITE 6
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-2583
Country	:	US
Telephone Number	:	956-546-3734
Fax Number	:	956-546-3747

Provider Business Practice Location Address
First Line	:	500 PAREDES LINE RD
Second Line	:	SUITE 6
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-2583
Country	:	US
Telephone Number	:	956-546-3734
Fax Number	:	956-546-3747

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. CLAUDIO J ORTIZ JR.
Credential	:
Telephone Number	:	956-546-3734

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/22/2020

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