MEDICARE: SOFTLAND LABS

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	:	1629736277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOFTLAND LABS

Provider Business Mailing Address
First Line	:	2620 TANGLEWILDE ST # 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-3203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 TANGLEWILDE ST # 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-3203
Country	:	US
Telephone Number	:	708-483-8496
Fax Number	:	708-397-4252

Authorized Official
Title or Position	:	CEO
Name	:	MS. CATHY WILLIAMS
Credential	:
Telephone Number	:	708-935-5459

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	12/01/2021

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Directions to “SOFTLAND LABS ” Practice Location

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