Provider Demographics
NPI:1326814922
Name:THE LAB COLUMBIA LLC
Entity Type:Organization
Organization Name:THE LAB COLUMBIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-888-5630
Mailing Address - Street 1:11134 BROAD RIVER RD
Mailing Address - Street 2:STE B PMB 1004
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:314-888-5630
Mailing Address - Fax:314-293-6711
Practice Address - Street 1:11134 BROAD RIVER RD
Practice Address - Street 2:STE B PMB 1004
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:314-888-5630
Practice Address - Fax:314-293-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory