MEDICARE: APEX CLINICAL 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	:	1396689980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APEX CLINICAL LAB LLC

Provider Business Mailing Address
First Line	:	2761 MILTON RD
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-7602
Country	:	US
Telephone Number	:	240-207-8382
Fax Number	:

Provider Business Practice Location Address
First Line	:	11133 SHADY TRL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4617
Country	:	US
Telephone Number	:	240-207-8382
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ETHAN JACOB LENZNER
Credential	:	MLT
Telephone Number	:	240-207-8382

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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