MEDICARE: 1ST STOP LABS 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	0000000	NC

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	:	1679060222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST STOP LABS LLC

Provider Business Mailing Address
First Line	:	2107 BEATTIES FORD RD STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-4373
Country	:	US
Telephone Number	:	980-213-5501
Fax Number	:	704-563-3356

Provider Business Practice Location Address
First Line	:	4920 ALBEMARLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6618
Country	:	US
Telephone Number	:	980-213-5501
Fax Number	:	704-563-3356

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TERESE D SWANN
Credential	:
Telephone Number	:	980-213-5501

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	04/19/2018

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