Provider Demographics
NPI:1134652514
Name:TSA LABS LLC
Entity Type:Organization
Organization Name:TSA LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CROALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-300-4520
Mailing Address - Street 1:4792 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2878
Mailing Address - Country:US
Mailing Address - Phone:754-300-4520
Mailing Address - Fax:
Practice Address - Street 1:11350 SW VILLAGE PKWY
Practice Address - Street 2:SUITE 311
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2352
Practice Address - Country:US
Practice Address - Phone:754-300-4520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory