MEDICARE: MY MEDEX LAB, 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	:	1225849805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY MEDEX LAB, LLC

Provider Business Mailing Address
First Line	:	4501 IRVINGTON AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2014
Country	:	US
Telephone Number	:	904-881-1693
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 IRVINGTON AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2014
Country	:	US
Telephone Number	:	904-881-1693
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH CONNELL
Credential	:
Telephone Number	:	888-726-1440

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	03/08/2025

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