MEDICARE: LOTUS LABS 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
2	261QH0100X	Health Service Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477204980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS LABS LLC

Provider Business Mailing Address
First Line	:	11747 JEFFERSON AVE STE 6C
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-1998
Country	:	US
Telephone Number	:	757-438-7004
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 CALHOUN ST
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23669-2434
Country	:	US
Telephone Number	:	757-438-7004
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VERONICA CHARITY BARNES
Credential	:	NP
Telephone Number	:	757-438-7004

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	01/17/2022

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Directions to “LOTUS LABS LLC ” Practice Location

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