MEDICARE: MODERN LAB SERVICES

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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1427772169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN LAB SERVICES

Provider Business Mailing Address
First Line	:	3578 HARTSEL DR STE E PMB 444
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920
Country	:	US
Telephone Number	:	719-500-6928
Fax Number	:

Provider Business Practice Location Address
First Line	:	5802 PIONEER MESA DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923
Country	:	US
Telephone Number	:	719-500-6928
Fax Number	:

Authorized Official
Title or Position	:	PHLEBOTOMIST
Name	:	MRS. STACY M HERNANDEZ
Credential	:	CPT
Telephone Number	:	719-500-6928

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	09/27/2022

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