MEDICARE: MEDICAL CENTER LABORATORIES II, LTD.

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	45D1052675	TX
2	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	:	1962438291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER LABORATORIES II, LTD.

Provider Business Mailing Address
First Line	:	2525 WEST BELLFORT
Second Line	:	STE 197
City	:	HOUSTON
State	:	TX
Zip	:	77054
Country	:	US
Telephone Number	:	713-661-8787
Fax Number	:	713-663-9218

Provider Business Practice Location Address
First Line	:	2525 W BELLFORT ST
Second Line	:	STE. # 197
City	:	HOUSTON
State	:	TX
Zip	:	77054-5000
Country	:	US
Telephone Number	:	713-661-8787
Fax Number	:	713-663-9218

Authorized Official
Title or Position	:	GENERAL PARTNER/PRESIDENT
Name	:	MR. WILLIAM MCLUCAS
Credential	:
Telephone Number	:	713-661-8787

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	11/10/2010

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