MEDICARE: SIEBEL DIAGNOSTIC LABORATORIES

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	:	1871538991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIEBEL DIAGNOSTIC LABORATORIES

Provider Business Mailing Address
First Line	:	8204 ELMBROOK DR
Second Line	:	SUITE 117
City	:	DALLAS
State	:	TX
Zip	:	75247-4067
Country	:	US
Telephone Number	:	214-276-0902
Fax Number	:	214-276-0906

Provider Business Practice Location Address
First Line	:	8204 ELMBROOK DR
Second Line	:	SUITE 117
City	:	DALLAS
State	:	TX
Zip	:	75247-4067
Country	:	US
Telephone Number	:	214-276-0902
Fax Number	:	214-276-0906

Authorized Official
Title or Position	:	OWNER
Name	:	ELSIE N YOUNG
Credential	:
Telephone Number	:	214-276-0902

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/22/2020

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