Provider Demographics
NPI:1093317885
Name:ADVOCATE HEALTH LAB, LLC
Entity Type:Organization
Organization Name:ADVOCATE HEALTH LAB, LLC
Other - Org Name:ADVOCATE CREDENTIALING SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:205-393-2327
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MS
Mailing Address - Zip Code:39327-0974
Mailing Address - Country:US
Mailing Address - Phone:205-393-2327
Mailing Address - Fax:855-918-4758
Practice Address - Street 1:227 N 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MS
Practice Address - Zip Code:39327-3932
Practice Address - Country:US
Practice Address - Phone:769-218-8891
Practice Address - Fax:855-918-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory