MEDICARE: ROCKLIO LABS 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	:	1871280511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKLIO LABS LLC

Provider Business Mailing Address
First Line	:	3740 N JOSEY LN STE 237
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2503
Country	:	US
Telephone Number	:	786-859-9052
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 N JOSEY LN STE 237
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2503
Country	:	US
Telephone Number	:	786-859-9052
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK MILLER
Credential	:
Telephone Number	:	786-859-9052

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	04/21/2023

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Directions to “ROCKLIO LABS LLC ” Practice Location

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