MEDICARE: EPIC REFERENCE LABS, 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	800027064	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HZ205A	OTHER		PTAN
2	10D2067916	OTHER		CLIA

General Provider Information

NPI Number	:	1952733438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPIC REFERENCE LABS, INC.

Provider Business Mailing Address
First Line	:	7960 CENTRAL INDUSTRIAL DR
Second Line	:	SUITE 120
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-3444
Country	:	US
Telephone Number	:	561-249-4434
Fax Number	:	561-557-8737

Provider Business Practice Location Address
First Line	:	7960 CENTRAL INDUSTRIAL DR
Second Line	:	SUITE 120
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-3444
Country	:	US
Telephone Number	:	561-249-4434
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SRI BHARAT MADIREDDY
Credential	:	PH.D.
Telephone Number	:	561-249-4317

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	05/16/2016

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