MEDICARE: ENDEAVOR DNA INC

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	:	1093318586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDEAVOR DNA INC

Provider Business Mailing Address
First Line	:	6955 N MESA ST STE 109
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4424
Country	:	US
Telephone Number	:	915-519-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6955 N MESA ST STE 109
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4424
Country	:	US
Telephone Number	:	915-519-1600
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	DANIEL SLOWINSKI
Credential	:
Telephone Number	:	915-519-1600

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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Directions to “ENDEAVOR DNA INC ” Practice Location

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