MEDICARE: BLG GROUP

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		TX

General Provider Information

NPI Number	:	1568691707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLG GROUP

Provider Business Mailing Address
First Line	:	2351 W NORTHWEST HWY STE 2240
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2351 W NORTHWEST HWY STE 2240
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:	214-674-7052
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARTUR AZATYAN
Credential	:
Telephone Number	:	214-674-7052

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	07/09/2009

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Directions to “BLG GROUP ” Practice Location

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