=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831898089
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEYSTONE LABS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2023
-----------------------------------------------------
Last Update Date | 08/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9122 W 88TH AVE
-----------------------------------------------------
City | ARVADA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80005-1540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-431-3691
-----------------------------------------------------
Fax | 754-289-2326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9122 W 88TH AVE
-----------------------------------------------------
City | ARVADA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80005-1540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-431-3691
-----------------------------------------------------
Fax | 754-289-2326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAAD KHALDOUN ALAMAWI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-940-1978
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------