MEDICARE: 48HRLABS.COM, 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	0302000934	AZ

General Provider Information

NPI Number	:	1477883973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	48HRLABS.COM, LLC

Provider Business Mailing Address
First Line	:	25 S ARIZONA PL
Second Line	:	SUITE 520
City	:	CHANDLER
State	:	AZ
Zip	:	85225-5533
Country	:	US
Telephone Number	:	480-615-3501
Fax Number	:

Provider Business Practice Location Address
First Line	:	4852 E BASELINE RD
Second Line	:	SUITE 104
City	:	MESA
State	:	AZ
Zip	:	85206-4627
Country	:	US
Telephone Number	:	480-615-3501
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	LATA PALL
Credential	:
Telephone Number	:	480-615-3501

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	01/05/2010

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