Provider Demographics
NPI:1093339970
Name:LABROVER
Entity Type:Organization
Organization Name:LABROVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGER
Authorized Official - Suffix:
Authorized Official - Credentials:MLS
Authorized Official - Phone:231-886-8898
Mailing Address - Street 1:2243 TAMARA RD NW
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-8941
Mailing Address - Country:US
Mailing Address - Phone:231-886-8898
Mailing Address - Fax:
Practice Address - Street 1:2243 TAMARA RD NW
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-8941
Practice Address - Country:US
Practice Address - Phone:269-830-7945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical TechnologistGroup - Multi-Specialty