Provider Demographics
NPI:1235917824
Name:A&C LAB LLC
Entity Type:Organization
Organization Name:A&C LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:AMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-668-2145
Mailing Address - Street 1:1914 J N PEASE PL STE 144
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4504
Mailing Address - Country:US
Mailing Address - Phone:704-668-2145
Mailing Address - Fax:
Practice Address - Street 1:1914 J N PEASE PL STE 144
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4504
Practice Address - Country:US
Practice Address - Phone:704-668-2145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No291U00000XLaboratoriesClinical Medical Laboratory
No305S00000XManaged Care OrganizationsPoint of Service