MEDICARE: CONFIRM LABORATORY 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	:	1548826043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONFIRM LABORATORY LLC

Provider Business Mailing Address
First Line	:	2828 FOREST LN STE 1119
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7500
Country	:	US
Telephone Number	:	972-707-0141
Fax Number	:	972-591-2981

Provider Business Practice Location Address
First Line	:	2828 FOREST LN STE 1119
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7500
Country	:	US
Telephone Number	:	972-707-0141
Fax Number	:	972-591-2981

Authorized Official
Title or Position	:	OWNER
Name	:	DAN DELANEY
Credential	:
Telephone Number	:	972-707-0141

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	05/10/2019

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