MEDICARE: ABS LABS 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	21975

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21975	OTHER		COLA

General Provider Information

NPI Number	:	1144671223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABS LABS LLC

Provider Business Mailing Address
First Line	:	1600 WALLACE DR
Second Line	:	SUITE 100
City	:	CARROLLTON
State	:	TX
Zip	:	75006-8006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 ARBUCKLE CT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4506
Country	:	US
Telephone Number	:	214-364-6850
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED PERSON
Name	:	JARED ROCHWERG
Credential	:
Telephone Number	:	917-817-6482

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	06/29/2016

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Directions to “ABS LABS LLC ” Practice Location

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