MEDICARE: MILLENNIUM HEALTH SERVICES, 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	800027244	FL

General Provider Information

NPI Number	:	1851708630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	4949 S CONGRESS AVE
Second Line	:	SUITE B
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4731
Country	:	US
Telephone Number	:	561-433-8500
Fax Number	:	561-601-1290

Provider Business Practice Location Address
First Line	:	4949 S CONGRESS AVE
Second Line	:	SUITE B
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4731
Country	:	US
Telephone Number	:	561-433-8500
Fax Number	:	561-601-1290

Authorized Official
Title or Position	:	CEO
Name	:	MR. LAWRENCE J BENTVENA
Credential	:
Telephone Number	:	561-433-8500

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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