Healthcare Provider Details

I. General information

NPI: 1356735476
Provider Name (Legal Business Name): QUALITY LAB LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 COMMERCIAL WAY
SPRING HILL FL
34606-1110
US

IV. Provider business mailing address

5427 COMMERCIAL WAY
SPRING HILL FL
34606-1110
US

V. Phone/Fax

Practice location:
  • Phone: 352-584-7452
  • Fax:
Mailing address:
  • Phone: 352-584-7452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number10D2090296
License Number StateFL

VIII. Authorized Official

Name: MR. MIRZA BAIG
Title or Position: OWNER
Credential:
Phone: 352-584-7452