MEDICARE: TPL FL, 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	:	1508255951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TPL FL, LLC

Provider Business Mailing Address
First Line	:	2463 QUANTUM BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8612
Country	:	US
Telephone Number	:	561-600-3484
Fax Number	:

Provider Business Practice Location Address
First Line	:	2463 QUANTUM BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8612
Country	:	US
Telephone Number	:	561-600-3484
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. JOSHUA DARBY
Credential	:
Telephone Number	:	337-436-9557

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	01/22/2015

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