MEDICARE: BURRELL MOBILE LAB

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	19D2055006	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346582400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURRELL MOBILE LAB

Provider Business Mailing Address
First Line	:	800 S 6TH ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-2228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 TOWER DR
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5045
Country	:	US
Telephone Number	:	504-210-6317
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEREMY BURRELL
Credential	:
Telephone Number	:	504-210-6317

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	03/26/2013

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Directions to “BURRELL MOBILE LAB ” Practice Location

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