MEDICARE: SIEMENS HEALTHCARE LABORATORY 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	05D0888918	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	800007851	OTHER	FL	291U00000X
2	733	OTHER	MD	291U00000X
3	PFI4995	OTHER	NY	291U00000X
4	05D0888918	OTHER	CA	291U00000X
5	LCO00477	OTHER	RI	291U00000X
6	023005	OTHER	PA	291U00000X
7	HIV-RL-23	OTHER	WV	291U00000X
8	CLF10781	OTHER	CA	291U00000X

General Provider Information

NPI Number	:	1295248193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIEMENS HEALTHCARE LABORATORY LLC

Provider Business Mailing Address
First Line	:	725 POTTER ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2722
Country	:	US
Telephone Number	:	510-982-4200
Fax Number	:	510-982-4203

Provider Business Practice Location Address
First Line	:	725 POTTER ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2722
Country	:	US
Telephone Number	:	510-982-4200
Fax Number	:	510-982-4203

Authorized Official
Title or Position	:	SR. MANAGER
Name	:	SANDRA CRUZ
Credential	:
Telephone Number	:	510-982-4080

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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Directions to “SIEMENS HEALTHCARE LABORATORY LLC ” Practice Location

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