MEDICARE: CAR GENETICS & MOLECULAR DIAGNOSTICS LAB

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	:	1841079670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAR GENETICS & MOLECULAR DIAGNOSTICS LAB

Provider Business Mailing Address
First Line	:	3024 E WOODSON LATERAL RD
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9169
Country	:	US
Telephone Number	:	870-534-2900
Fax Number	:	870-534-9726

Provider Business Practice Location Address
First Line	:	3024 E WOODSON LATERAL RD
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9169
Country	:	US
Telephone Number	:	870-534-2900
Fax Number	:	870-534-9726

Authorized Official
Title or Position	:	OWNER
Name	:	MISHA MAHMOOD
Credential	:
Telephone Number	:	870-534-2900

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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