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General NPI Number Information
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NPI Number | 1578132924
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Entity Type | Organization
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Legal Business Name | LAB TEST123 LABORATORY SERVICES, INC
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 8333 W MCNAB RD STE 228
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City | TAMARAC
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State | FL
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Zip | 33321-3241
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Country | US
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Telephone | 754-256-5070
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Fax | 754-256-5071
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Provider Business Mailing Address
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Address Line | 8333 W MCNAB RD STE 228
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City | TAMARAC
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State | FL
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Zip | 33321-3241
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Country | US
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Telephone | 754-256-5070
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Fax |
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Authorized Official
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Title or Position | LABORATORY OPERATIONS MANAGER
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Name | CHARITE E MARCELLUS
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Credential |
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Telephone | 754-256-5075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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