MEDICARE: UTOPIAN LAB SOLUTIONS 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	:	1811655970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTOPIAN LAB SOLUTIONS LLC.

Provider Business Mailing Address
First Line	:	5959 FORT CAROLINE RD APT 1702
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1842
Country	:	US
Telephone Number	:	904-322-4351
Fax Number	:	866-321-0366

Provider Business Practice Location Address
First Line	:	4016 SOUTH THIRD STREET #1016
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3225
Country	:	US
Telephone Number	:	904-322-4351
Fax Number	:	866-321-0366

Authorized Official
Title or Position	:	OWNER
Name	:	TAMMY WOODS
Credential	:	LPN
Telephone Number	:	904-322-4351

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	02/25/2022

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