MEDICARE: 2920 LAB, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D0932241	OTHER		CLIA

General Provider Information

NPI Number	:	1427204189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2920 LAB, LLC

Provider Business Mailing Address
First Line	:	6225 FM 2920 RD
Second Line	:	SUITE 170
City	:	SPRING
State	:	TX
Zip	:	77379-3474
Country	:	US
Telephone Number	:	281-257-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	6225 FM 2920 RD
Second Line	:	SUITE 170
City	:	SPRING
State	:	TX
Zip	:	77379-3474
Country	:	US
Telephone Number	:	281-257-0404
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BILLING
Name	:	MRS. SIAN NAVA
Credential	:
Telephone Number	:	832-585-2447

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	08/13/2008

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