MEDICARE: SANITAS HEALTH CARE 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	45D2084804	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D2084804	OTHER	TX	CLIA

General Provider Information

NPI Number	:	1619371598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANITAS HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 732843
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-2843
Country	:	US
Telephone Number	:	214-618-5600
Fax Number	:	214-618-7733

Provider Business Practice Location Address
First Line	:	2422 ARBUCKLE CT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4506
Country	:	US
Telephone Number	:	844-245-9714
Fax Number	:	888-509-2958

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	KIM SIVARAMAN
Credential	:
Telephone Number	:	214-618-5600

Provider Enumeration Date	:	10/21/2014
Last Update Date	:	08/28/2015

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Directions to “SANITAS HEALTH CARE LLC ” Practice Location

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