Healthcare Provider Details

I. General information

NPI: 1326549734
Provider Name (Legal Business Name): BEX LAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 S US HIGHWAY 1 STE 402
PORT ST LUCIE FL
34952-1449
US

IV. Provider business mailing address

7410 S US HIGHWAY 1 STE 402
PORT ST LUCIE FL
34952-1449
US

V. Phone/Fax

Practice location:
  • Phone: 561-846-1637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ROUSSEAU
Title or Position: CEO
Credential:
Phone: 561-846-1637