MEDICARE: MOLECULAR CLINICAL 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

General Provider Information

NPI Number	:	1720734163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLECULAR CLINICAL LABORATORY, INC

Provider Business Mailing Address
First Line	:	3760 NW 126TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2408
Country	:	US
Telephone Number	:	954-906-5092
Fax Number	:	954-906-5088

Provider Business Practice Location Address
First Line	:	3760 NW 126TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2408
Country	:	US
Telephone Number	:	954-906-5092
Fax Number	:	954-906-5088

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ARLENE HALL
Credential	:
Telephone Number	:	954-906-5261

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	06/02/2022

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