MEDICARE: THE XPRESS LAB, 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1962108670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE XPRESS LAB, LLC

Provider Business Mailing Address
First Line	:	1916 TOM SADLER RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-7461
Country	:	US
Telephone Number	:	910-524-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 E CHARLOTTE AVE STE K
Second Line	:
City	:	MT HOLLY
State	:	NC
Zip	:	28120-2274
Country	:	US
Telephone Number	:	704-208-1855
Fax Number	:	704-208-1855

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ALICIA JENKINS
Credential	:
Telephone Number	:	704-208-1855

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	02/03/2023

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Directions to “THE XPRESS LAB, LLC ” Practice Location

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