MEDICARE: MLIFE LABORATORIES 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

General Provider Information

NPI Number	:	1588392344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MLIFE LABORATORIES LLC

Provider Business Mailing Address
First Line	:	511 N WASHINGTON AVE
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75670-2007
Country	:	US
Telephone Number	:	408-605-7300
Fax Number	:	877-347-8075

Provider Business Practice Location Address
First Line	:	8313 SOUTHWEST FWY STE 321
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1656
Country	:	US
Telephone Number	:	832-653-2894
Fax Number	:	832-653-2893

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	ALAN LOUDERMILK
Credential	:
Telephone Number	:	408-605-7300

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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