=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134092471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 850 LABS TO GO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2025
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6954 W HIGHWAY 98 APT 2-102
-----------------------------------------------------
City | PANAMA CITY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32407-5433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-630-2667
-----------------------------------------------------
Fax | 754-339-0030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6954 W HIGHWAY 98 APT 102
-----------------------------------------------------
City | PANAMA CITY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32407-5459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-630-2667
-----------------------------------------------------
Fax | 754-339-0030
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, CFO, DIRECTOR, COLLECTOR
-----------------------------------------------------
Name | MS. CASSIDY ROSE BACON
-----------------------------------------------------
Credential | CPT, CCMA
-----------------------------------------------------
Telephone | 850-630-2667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247ZC0005X
-----------------------------------------------------
Taxonomy Name | Clinical Laboratory Director (Non-physician)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------