MEDICARE: NEOGENOMICS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D2167801	OTHER	CA	CLIA
2	CLF-00353852	OTHER	CA	CDPH CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE

General Provider Information

NPI Number	:	1215625165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEOGENOMICS LABORATORIES INC

Provider Business Mailing Address
First Line	:	PO BOX 947365
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30394-7365
Country	:	US
Telephone Number	:	866-776-5907
Fax Number	:	888-443-4153

Provider Business Practice Location Address
First Line	:	4570 EXECUTIVE DR STE 250
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3074
Country	:	US
Telephone Number	:	866-776-5907
Fax Number	:	888-443-4153

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JEFFREY S. SHERMAN
Credential	:
Telephone Number	:	866-776-5907

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	04/28/2023

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