MEDICARE: WILLIAM R. JANACEK

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	:	1730136821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM R. JANACEK

Provider Business Mailing Address
First Line	:	1209 WASHINGTON ST
Second Line	:
City	:	COMMERCE
State	:	TX
Zip	:	75428-2613
Country	:	US
Telephone Number	:	903-886-1067
Fax Number	:	903-886-4501

Provider Business Practice Location Address
First Line	:	1209 WASHINGTON ST
Second Line	:
City	:	COMMERCE
State	:	TX
Zip	:	75428-2613
Country	:	US
Telephone Number	:	903-886-1067
Fax Number	:	903-886-4501

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM RYAN JANACEK
Credential	:
Telephone Number	:	903-886-1067

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/22/2020

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