Healthcare Provider Details

I. General information

NPI: 1386745032
Provider Name (Legal Business Name): LLH LABS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL LN
FOREST MS
39074-4039
US

IV. Provider business mailing address

PO BOX 600
FOREST MS
39074-0600
US

V. Phone/Fax

Practice location:
  • Phone: 601-469-4861
  • Fax: 601-469-1238
Mailing address:
  • Phone: 601-469-4861
  • Fax: 601-469-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: VICKIE D HARALSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-469-4861