Provider Demographics
NPI:1225705353
Name:C19 RAPID TESTING SOLUTION LLC
Entity Type:Organization
Organization Name:C19 RAPID TESTING SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:786-351-5729
Mailing Address - Street 1:2304 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-7608
Mailing Address - Country:US
Mailing Address - Phone:786-351-5729
Mailing Address - Fax:
Practice Address - Street 1:200 PARK VIEW CT
Practice Address - Street 2:
Practice Address - City:LIZELLA
Practice Address - State:GA
Practice Address - Zip Code:31052-3621
Practice Address - Country:US
Practice Address - Phone:786-351-5729
Practice Address - Fax:
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?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty