MEDICARE: RECOVERY LABORATORIES 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	:	1013389808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY LABORATORIES LLC

Provider Business Mailing Address
First Line	:	2422 ARBUCKLE CT
Second Line	:	SUITE A
City	:	DALLAS
State	:	TX
Zip	:	75229-4506
Country	:	US
Telephone Number	:	844-246-0912
Fax Number	:	888-509-0898

Provider Business Practice Location Address
First Line	:	2422 ARBUCKLE CT
Second Line	:	SUITE A
City	:	DALLAS
State	:	TX
Zip	:	75229-4506
Country	:	US
Telephone Number	:	844-246-0912
Fax Number	:	888-509-0898

Authorized Official
Title or Position	:	LAB DIRECTOR
Name	:	KEVIN MCQUAID
Credential	:	M.D
Telephone Number	:	844-246-0912

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	10/20/2015

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