MEDICARE: SFMC LABORATORY

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		MS

General Provider Information

NPI Number	:	1730449372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SFMC LABORATORY

Provider Business Mailing Address
First Line	:	124 S MAIN ST
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-1721
Country	:	US
Telephone Number	:	662-857-5069
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 S MAIN ST
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-1721
Country	:	US
Telephone Number	:	662-857-5069
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LINDA L TROY
Credential	:	FNP
Telephone Number	:	662-487-1064

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	05/16/2012

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Directions to “SFMC LABORATORY ” Practice Location

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