MEDICARE: CLINICAL LAB TESTING

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1710817119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL LAB TESTING

Provider Business Mailing Address
First Line	:	7230 NIGHTINGALE HILL LN APT 404
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3099
Country	:	US
Telephone Number	:	307-622-9550
Fax Number	:

Provider Business Practice Location Address
First Line	:	7230 NIGHTINGALE HILL LN APT 404
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3099
Country	:	US
Telephone Number	:	307-622-9550
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAHID AFZAAL
Credential	:
Telephone Number	:	307-622-9550

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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