Provider Demographics
NPI:1114223500
Name:ON DEMAND LAB TEST LLC
Entity Type:Organization
Organization Name:ON DEMAND LAB TEST LLC
Other - Org Name:ON DEMAND MEDICAL TESTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-206-9326
Mailing Address - Street 1:1551 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-1801
Mailing Address - Country:US
Mailing Address - Phone:601-206-9326
Mailing Address - Fax:601-957-7344
Practice Address - Street 1:1551 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-1801
Practice Address - Country:US
Practice Address - Phone:601-206-9326
Practice Address - Fax:601-957-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory