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General NPI Number Information
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NPI Number | 1306649710
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Entity Type | Organization
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Legal Business Name | LRC TESTING CENTER
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 11709 FRUEHAUF DR STE 113
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City | CHARLOTTE
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State | NC
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Zip | 28273-7285
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Country | US
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Telephone | 803-713-5283
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Fax |
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Provider Business Mailing Address
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Address Line | 11709 FRUEHAUF DR STE 113
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City | CHARLOTTE
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State | NC
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Zip | 28273-7285
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JAZMINE MCFADDEN
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Credential | CADC
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Telephone | 803-404-7789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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