MEDICARE: SYNERGY LABORATORIES, 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	4648LIC-1	NV

General Provider Information

NPI Number	:	1205090073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY LABORATORIES, INC.

Provider Business Mailing Address
First Line	:	1000 N GREEN VALLEY PKWY
Second Line	:	SUITE #440-249
City	:	HENDERSON
State	:	NV
Zip	:	89074-6170
Country	:	US
Telephone Number	:	702-220-9159
Fax Number	:	702-263-9388

Provider Business Practice Location Address
First Line	:	4161 S EASTERN AVE
Second Line	:	SUITE A-6
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5484
Country	:	US
Telephone Number	:	702-220-9159
Fax Number	:	702-248-6486

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MYRA TAIGMAN-FARRELL
Credential	:
Telephone Number	:	702-220-9159

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/10/2008

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