MEDICARE: MEDIWELL LAB CORPORATION

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	:	1215809413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIWELL LAB CORPORATION

Provider Business Mailing Address
First Line	:	5005 W ROYAL LN STE 250
Second Line	:	250
City	:	IRVING
State	:	TX
Zip	:	75063-1961
Country	:	US
Telephone Number	:	945-221-7760
Fax Number	:	945-262-6051

Provider Business Practice Location Address
First Line	:	5005 W ROYAL LN STE 250
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-1961
Country	:	US
Telephone Number	:	945-342-8624
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PIYUSH ARUN PATIL
Credential	:	MD
Telephone Number	:	945-342-8624

Provider Enumeration Date	:	09/18/2025
Last Update Date	:	10/01/2025

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