Provider Demographics
NPI:1346571775
Name:RANKIN LABORATORIES LLC
Entity Type:Organization
Organization Name:RANKIN LABORATORIES LLC
Other - Org Name:LOR DIAGNOSTICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RHEA
Authorized Official - Last Name:WATERLOO
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:601-401-9077
Mailing Address - Street 1:2550 FLOWOOD DR STE 301
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9306
Mailing Address - Country:US
Mailing Address - Phone:601-401-9077
Mailing Address - Fax:601-401-9078
Practice Address - Street 1:2550 FLOWOOD DR
Practice Address - Street 2:SUITE 301
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9303
Practice Address - Country:US
Practice Address - Phone:601-936-0463
Practice Address - Fax:601-936-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Multi-Specialty