MEDICARE: GEAUX MAJOR HEALTH 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1578152245	OTHER	FL	NPI

General Provider Information

NPI Number	:	1073198404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEAUX MAJOR HEALTH LLC

Provider Business Mailing Address
First Line	:	6961 RED ROBIN DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3668
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6961 RED ROBIN DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3668
Country	:	US
Telephone Number	:	318-458-9716
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LASHEDAKA SANDERS
Credential	:
Telephone Number	:	318-458-9716

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	05/28/2021

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Directions to “GEAUX MAJOR HEALTH LLC ” Practice Location

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