Provider Demographics
NPI:1174189849
Name:RO SMOCK & ASSOCIATES LLC
Entity Type:Organization
Organization Name:RO SMOCK & ASSOCIATES LLC
Other - Org Name:ATLANTIC LABS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-255-1190
Mailing Address - Street 1:4310 WILEY POST RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4295
Mailing Address - Country:US
Mailing Address - Phone:505-255-1190
Mailing Address - Fax:505-345-5799
Practice Address - Street 1:4310 WILEY POST RD STE 100
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4295
Practice Address - Country:US
Practice Address - Phone:505-255-1190
Practice Address - Fax:505-345-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory