Healthcare Provider Details

I. General information

NPI: 1750032884
Provider Name (Legal Business Name): PROLABS OF NC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CONSULTANT PL STE 200
DURHAM NC
27707-3598
US

IV. Provider business mailing address

6 CONSULTANT PL STE 200
DURHAM NC
27707-3598
US

V. Phone/Fax

Practice location:
  • Phone: 919-672-5592
  • Fax: 919-573-0937
Mailing address:
  • Phone: 919-672-5592
  • Fax: 919-573-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATARSHA CRUMPLER
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 919-672-5592