=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295196780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LLD LABORATORIES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2016
-----------------------------------------------------
Last Update Date | 06/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 249 E NC HIGHWAY 54 SUITE 310
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-7512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-753-1080
-----------------------------------------------------
Fax | 919-753-1089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 249 E NC HIGHWAY 54 STE 310
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-907-3334
-----------------------------------------------------
Fax | 919-813-2269
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. LAUREN ELIZABETH DURANT
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 919-907-3334
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------