MEDICARE: BERNHARDT LABORATORIES 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	800001509	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417960626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNHARDT LABORATORIES INC

Provider Business Mailing Address
First Line	:	1355 RIVER BEND DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4915
Country	:	US
Telephone Number	:	561-514-5822
Fax Number	:	844-751-9262

Provider Business Practice Location Address
First Line	:	3728 PHILIPS HWY STE 60
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-6898
Country	:	US
Telephone Number	:	904-296-2333
Fax Number	:	904-296-8467

Authorized Official
Title or Position	:	DIRECTOR, CREDENTIALING & PE
Name	:	DINA VALLADARES
Credential	:
Telephone Number	:	561-514-5822

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	04/07/2026

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