MEDICARE: GPOWELL 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	:	1699403303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GPOWELL LLC

Provider Business Mailing Address
First Line	:	1785 NE 162ND ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4757
Country	:	US
Telephone Number	:	954-864-0841
Fax Number	:

Provider Business Practice Location Address
First Line	:	1785 NE 162ND ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4757
Country	:	US
Telephone Number	:	954-864-0841
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GLENROY SHANE POWELL
Credential	:	LAB DICTOR
Telephone Number	:	954-864-0841

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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