MEDICARE: SKIPPACK MEDICAL 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	291U00000X	Clinical Medical Laboratory		PA

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	:	1962804088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKIPPACK MEDICAL LAB, LLC

Provider Business Mailing Address
First Line	:	200 RITTENHOUSE CIR UNIT 9
Second Line	:
City	:	BRISTOL
State	:	PA
Zip	:	19007-1619
Country	:	US
Telephone Number	:	610-584-1669
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 RITTENHOUSE CIRCLE EAST
Second Line	:	SUITE 9
City	:	BRISTOL
State	:	PA
Zip	:	19007-1619
Country	:	US
Telephone Number	:	610-584-1669
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AABEDA VAHORA
Credential	:
Telephone Number	:	610-584-1669

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	03/19/2020

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Directions to “SKIPPACK MEDICAL LAB, LLC ” Practice Location

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