MEDICARE: MEDPLEX LABORATORIES

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	:	1053480814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPLEX LABORATORIES

Provider Business Mailing Address
First Line	:	7271 WURZBACH RD STE 127
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4718
Country	:	US
Telephone Number	:	210-614-7823
Fax Number	:	210-614-3379

Provider Business Practice Location Address
First Line	:	7271 WURZBACH RD STE 127
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4718
Country	:	US
Telephone Number	:	210-614-7823
Fax Number	:	210-614-3379

Authorized Official
Title or Position	:	LAB MANAGER
Name	:	MR. CHARLES RENDON
Credential	:
Telephone Number	:	210-614-7823

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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