Provider Demographics
NPI:1215014493
Name:AK MOLECULAR DIAGNOSTIC LABORATORY, LLC
Entity Type:Organization
Organization Name:AK MOLECULAR DIAGNOSTIC LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LAB MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MT(ASCP), CLSP(M
Authorized Official - Phone:254-741-6363
Mailing Address - Street 1:1000 W STATE HIGHWAY 6
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3786
Mailing Address - Country:US
Mailing Address - Phone:254-741-6363
Mailing Address - Fax:
Practice Address - Street 1:1000 W STATE HIGHWAY 6
Practice Address - Street 2:SUITE 230
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3786
Practice Address - Country:US
Practice Address - Phone:254-741-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory