MEDICARE: SPECIALTY LABORATORIES INC

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	05D0550302	CA

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	:	1811997711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY LABORATORIES INC

Provider Business Mailing Address
First Line	:	14275 MIDWAY RD STE 400
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-3661
Country	:	US
Telephone Number	:	866-697-8378
Fax Number	:

Provider Business Practice Location Address
First Line	:	8407 FALLBROOK AVE STE 100
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-3252
Country	:	US
Telephone Number	:	800-421-7110
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	LEAH D TIMMERMAN
Credential	:
Telephone Number	:	973-520-2700

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	12/16/2024

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Directions to “SPECIALTY LABORATORIES INC ” Practice Location

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