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General NPI Number Information
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NPI Number | 1982142345
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Entity Type | Organization
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Legal Business Name | ADVANTIS LABORATORIES LLC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 256 GRETAS WAY STE 105
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City | KERNERSVILLE
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State | NC
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Zip | 27284-3889
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Country | US
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Telephone | 843-429-1530
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3664
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City | SEATTLE
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State | WA
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Zip | 98124-3664
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Country | US
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Telephone | 843-429-1530
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IMAD OSKO
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Credential |
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Telephone | 843-429-1530
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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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