MEDICARE: 1420 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

General Provider Information

NPI Number	:	1205794815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1420 LABS LLC

Provider Business Mailing Address
First Line	:	314 W RILEY FUZZEL RD BLDG 3
Second Line	:	SUITE 109
City	:	SPRING
State	:	TX
Zip	:	77373-8396
Country	:	US
Telephone Number	:	281-940-4628
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 W RILEY FUZZEL RD BLDG 3
Second Line	:	SUITE 109
City	:	SPRING
State	:	TX
Zip	:	77373-8396
Country	:	US
Telephone Number	:	281-940-4628
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JIM DUCHESS
Credential	:
Telephone Number	:	412-781-2162

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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