MEDICARE: SURE RESULTS LABORATORY 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	291U00000X	Clinical Medical Laboratory	321-0003140	FL

General Provider Information

NPI Number	:	1710066105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURE RESULTS LABORATORY INC

Provider Business Mailing Address
First Line	:	7109 SPORTSMANS DR
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-5433
Country	:	US
Telephone Number	:	954-865-4243
Fax Number	:	954-722-2537

Provider Business Practice Location Address
First Line	:	7109 SPORTSMANS DR
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-5433
Country	:	US
Telephone Number	:	954-865-4243
Fax Number	:	954-722-2537

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHERRI L MARTINEZ
Credential	:
Telephone Number	:	954-865-4243

Provider Enumeration Date	:	11/04/2006
Last Update Date	:	08/22/2020

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