Healthcare Provider Details

I. General information

NPI: 1801554589
Provider Name (Legal Business Name): UPLIFT DIAGNOSTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E WASHINGTON ST
LA GRANGE NC
28551-1856
US

IV. Provider business mailing address

PO BOX 254
LA GRANGE NC
28551-0254
US

V. Phone/Fax

Practice location:
  • Phone: 252-566-3010
  • Fax:
Mailing address:
  • Phone: 252-566-3010
  • Fax:

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: SHAMEKA CAMPBELL
Title or Position: PRESIDENT
Credential:
Phone: 765-409-9633