Provider Demographics
NPI:1326482910
Name:OBX LABORATORIES, LLC
Entity Type:Organization
Organization Name:OBX LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER/PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSSUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-644-0030
Mailing Address - Street 1:1313 VALWOOD PKWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006
Mailing Address - Country:US
Mailing Address - Phone:940-220-7496
Mailing Address - Fax:866-731-1999
Practice Address - Street 1:1313 VALWOOD PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006
Practice Address - Country:US
Practice Address - Phone:940-220-7496
Practice Address - Fax:866-731-1999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OBX LABORATORIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-25
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory