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NPI Code Detail

MEDICARE: EXPRESS LAB SERVICES, LLC

MEDICARE: EXPRESS LAB SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/Center

General Provider Information

NPI Number : 1053076844
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXPRESS LAB SERVICES, LLC
Provider Business Mailing Address
First Line : 6361 TALOKAS LN STE C140-208
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-5642
Country : US
Telephone Number : 706-786-2636
Fax Number : 706-204-3805
Provider Business Practice Location Address
First Line : 6361 TALOKAS LN STE C140-208
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-5642
Country : US
Telephone Number : 706-786-2636
Fax Number : 706-204-3805
Authorized Official
Title or Position : OWNER
Name : ANDREKA THRASH
Credential : RN
Telephone Number : 706-358-1534
Provider Enumeration Date : 11/05/2021
Last Update Date : 11/05/2021

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Directions to “EXPRESS LAB SERVICES, LLC ” Practice Location

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