MEDICARE: RM LAB 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	13D0520868	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659301349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RM LAB LLC

Provider Business Mailing Address
First Line	:	3910 WASHINGTON PKWY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7596
Country	:	US
Telephone Number	:	208-529-8330
Fax Number	:	208-884-4611

Provider Business Practice Location Address
First Line	:	2220 E 25TH ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7542
Country	:	US
Telephone Number	:	208-529-8330
Fax Number	:	208-523-3318

Authorized Official
Title or Position	:	CEO
Name	:	VON CROFTS
Credential	:
Telephone Number	:	208-523-1122

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	10/02/2014

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Directions to “RM LAB LLC ” Practice Location

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