MEDICARE: PACE SET MEDICS LLC

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	:	1770187817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACE SET MEDICS LLC

Provider Business Mailing Address
First Line	:	223 PELTON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-1537
Country	:	US
Telephone Number	:	347-886-5828
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 PELTON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-1537
Country	:	US
Telephone Number	:	347-886-5828
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ADAM MICHAEL PACE
Credential	:	EMT-PARAMEDIC
Telephone Number	:	347-886-5828

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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