Provider Demographics
NPI:1215604376
Name:SJB DIAGNOSTIC SCREENING LLC
Entity Type:Organization
Organization Name:SJB DIAGNOSTIC SCREENING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-215-5006
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:MARSHALLS CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18335-1386
Mailing Address - Country:US
Mailing Address - Phone:570-664-4498
Mailing Address - Fax:570-774-4600
Practice Address - Street 1:323 DARTMOUTH DRIVE
Practice Address - Street 2:UNIT 4
Practice Address - City:MARSHALLS CREEK
Practice Address - State:PA
Practice Address - Zip Code:18335-1833
Practice Address - Country:US
Practice Address - Phone:570-215-5006
Practice Address - Fax:570-774-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory