MEDICARE: MEDICAL LABORATORY SERVICE 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

General Provider Information

NPI Number	:	1306350194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL LABORATORY SERVICE INC

Provider Business Mailing Address
First Line	:	31700 W 13 MILE RD # 218
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2166
Country	:	US
Telephone Number	:	248-907-3985
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 BROOKLYN RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4750
Country	:	US
Telephone Number	:	517-997-1000
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MARY IOCCA-SMITH
Credential	:
Telephone Number	:	517-206-7267

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	05/23/2025

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