MEDICARE: ACIES MOLECULAR 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518600758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACIES MOLECULAR LAB LLC

Provider Business Mailing Address
First Line	:	4000 DISCOVERY CT
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 DISCOVERY CT
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150
Country	:	US
Telephone Number	:	502-468-3950
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MARVIN LEE SCHMIDT JR.
Credential	:	PHD
Telephone Number	:	502-468-3950

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	04/15/2022

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