MEDICARE: MEDCARE DIAGNOSTICS OF AMERICA

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	:	1518225069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDCARE DIAGNOSTICS OF AMERICA

Provider Business Mailing Address
First Line	:	501 AVIATOR DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-5416
Country	:	US
Telephone Number	:	800-856-4070
Fax Number	:	817-439-3468

Provider Business Practice Location Address
First Line	:	501 AVIATOR DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-5416
Country	:	US
Telephone Number	:	800-856-4070
Fax Number	:	817-439-3468

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. RHYNE NYLAAN
Credential	:
Telephone Number	:	800-856-4070

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	05/02/2012

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