Provider Demographics
NPI:1093072365
Name:COMPLAB LLC
Entity Type:Organization
Organization Name:COMPLAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDRIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-284-8355
Mailing Address - Street 1:PO BOX 14802
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34280-4802
Mailing Address - Country:US
Mailing Address - Phone:855-233-3755
Mailing Address - Fax:941-243-3854
Practice Address - Street 1:2 N TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6328
Practice Address - Country:US
Practice Address - Phone:941-243-3855
Practice Address - Fax:941-243-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service