Healthcare Provider Details

I. General information

NPI: 1982373361
Provider Name (Legal Business Name): SPEEDY LABS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11518 N PORT WASHINGTON RD STE 1
MEQUON WI
53092-3443
US

IV. Provider business mailing address

11518 N PORT WASHINGTON RD STE 1
MEQUON WI
53092-3443
US

V. Phone/Fax

Practice location:
  • Phone: 262-834-9010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KIZZIE BLAND
Title or Position: DIRECTOR
Credential:
Phone: 414-418-4410