MEDICARE: BULLSEYE MOBILE EXPRESS LAB, 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	:	1396688420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BULLSEYE MOBILE EXPRESS LAB, LLC

Provider Business Mailing Address
First Line	:	820 W COTTONWOOD LN STE 9
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-2239
Country	:	US
Telephone Number	:	602-737-3001
Fax Number	:	520-518-5010

Provider Business Practice Location Address
First Line	:	820 W COTTONWOOD LN STE 9
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-2239
Country	:	US
Telephone Number	:	602-737-3001
Fax Number	:	520-518-5010

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MISS DIMECA CALVERT
Credential	:	CPT,NHA
Telephone Number	:	602-737-3001

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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