Provider Demographics
NPI:1245767870
Name:PEDIALABS, LLC
Entity Type:Organization
Organization Name:PEDIALABS, LLC
Other - Org Name:PEDIALABS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-468-2917
Mailing Address - Street 1:4653 S LAKESHORE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7161
Mailing Address - Country:US
Mailing Address - Phone:480-395-3972
Mailing Address - Fax:480-503-8138
Practice Address - Street 1:4653 S LAKESHORE DR STE 1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7161
Practice Address - Country:US
Practice Address - Phone:480-395-3972
Practice Address - Fax:480-503-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-14
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ299660291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty