MEDICARE: SKY LAB DIAGNOSTIC CENTER 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922718154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKY LAB DIAGNOSTIC CENTER LLC

Provider Business Mailing Address
First Line	:	2825 N UNIVERSITY DR STE 410
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5020
Country	:	US
Telephone Number	:	754-212-4864
Fax Number	:	754-225-9362

Provider Business Practice Location Address
First Line	:	2825 N UNIVERSITY DR STE 410
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5020
Country	:	US
Telephone Number	:	754-212-4864
Fax Number	:	754-225-9362

Authorized Official
Title or Position	:	DIRECTOR
Name	:	FRANCIS ROCHA
Credential	:
Telephone Number	:	786-367-4043

Provider Enumeration Date	:	11/29/2022
Last Update Date	:	07/21/2023

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