MEDICARE: TEXAS MEDICAL LABORATORY 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	45D0928347	TX

General Provider Information

NPI Number	:	1497086375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS MEDICAL LABORATORY INC

Provider Business Mailing Address
First Line	:	1777 NE LOOP 410
Second Line	:	STE 650
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5209
Country	:	US
Telephone Number	:	214-988-9242
Fax Number	:	214-593-4722

Provider Business Practice Location Address
First Line	:	1777 NE LOOP 410
Second Line	:	STE 650
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5209
Country	:	US
Telephone Number	:	214-988-9242
Fax Number	:	214-593-4722

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN B ARKUSINSKI
Credential	:	M.D.
Telephone Number	:	214-988-9242

Provider Enumeration Date	:	01/17/2010
Last Update Date	:	02/05/2010

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