=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003066754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2008
-----------------------------------------------------
Last Update Date | 09/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 N 3RD ST SUITE 279
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19123-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-488-4480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6933-B SOUTH REVERE PKWY
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-528-4770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | ELIZABETH HEARTY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-528-4770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 39D1088340
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------