MEDICARE: COMMUNITY TESTING SERVICES 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	:	1174275499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY TESTING SERVICES LLC

Provider Business Mailing Address
First Line	:	500 SENECA ST STE 302
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14204-1963
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 SENECA ST STE 302
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14204-1963
Country	:	US
Telephone Number	:	716-214-0498
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVE CARR
Credential	:
Telephone Number	:	716-214-0498

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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