MEDICARE: URGENT COVID TESTING, 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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1679168439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENT COVID TESTING, LLC

Provider Business Mailing Address
First Line	:	6909 TULANE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-2822
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6909 TULANE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-2822
Country	:	US
Telephone Number	:	916-715-7253
Fax Number	:

Authorized Official
Title or Position	:	LABORATORY DIRECTOR
Name	:	LILLIAN R GHALY
Credential	:	M.S.
Telephone Number	:	916-715-7253

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	03/03/2021

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