MEDICARE: SPECIALTY LABORATORIES, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	0028276B	TX
2	291U00000X	Clinical Medical Laboratory		TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659364784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY LABORATORIES, INC.

Provider Business Mailing Address
First Line	:	7111 FAIRWAY DR
Second Line	:	SUITE 400
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4204
Country	:	US
Telephone Number	:	561-712-6265
Fax Number	:	561-712-7349

Provider Business Practice Location Address
First Line	:	1325 E DURANGO BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-1724
Country	:	US
Telephone Number	:	210-581-0574
Fax Number	:	210-581-1456

Authorized Official
Title or Position	:	VP, MANAGED CARE
Name	:	MICHAEL GREENE
Credential	:
Telephone Number	:	214-932-8270

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	04/01/2008

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MEDICARE: SPECIALTY LABORATORIES, INC.

Scope of Practice

Other Identifiers

General Provider Information

Similar Medicare Providers

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