Provider Demographics
NPI:1104389766
Name:MAYS LANDING DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:MAYS LANDING DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEVELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:772-210-4338
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-0721
Mailing Address - Country:US
Mailing Address - Phone:772-210-4338
Mailing Address - Fax:
Practice Address - Street 1:823 SE OSCEOLA ST STE 4
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2431
Practice Address - Country:US
Practice Address - Phone:772-210-4338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29448OtherCOLA
FL10D2164233OtherCLIA