MEDICARE: D-LAB SERVICES 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	:	1346841202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D-LAB SERVICES LLC

Provider Business Mailing Address
First Line	:	3022 MOTLEY DR STE 300
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-3440
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3022 MOTLEY DR STE 300
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-3440
Country	:	US
Telephone Number	:	214-367-6161
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JERRILL RAJU
Credential	:
Telephone Number	:	469-583-2295

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	11/05/2020

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