MEDICARE: TOTAL LAB CARE 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	800027316	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10D2077557	OTHER	FL	CLIA ID NUMBER
2	800027316	OTHER	FL	ACHA LICENSE

General Provider Information

NPI Number	:	1306240171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL LAB CARE LLC

Provider Business Mailing Address
First Line	:	7685 103RD ST
Second Line	:	SUITE A1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-9325
Country	:	US
Telephone Number	:	904-647-7404
Fax Number	:	904-394-5115

Provider Business Practice Location Address
First Line	:	7685 103RD ST
Second Line	:	SUITE A1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-9325
Country	:	US
Telephone Number	:	904-647-7404
Fax Number	:	904-394-5115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SYED S HUSSAIN
Credential	:	MD
Telephone Number	:	904-647-7404

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	10/22/2014

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Directions to “TOTAL LAB CARE LLC ” Practice Location

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