Provider Demographics
NPI:1407380215
Name:LAB CRAFT, LLC
Entity Type:Organization
Organization Name:LAB CRAFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-418-1825
Mailing Address - Street 1:11248 S NANDINA AVE
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2026
Mailing Address - Country:US
Mailing Address - Phone:918-418-1825
Mailing Address - Fax:
Practice Address - Street 1:11248 S NANDINA AVE
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2026
Practice Address - Country:US
Practice Address - Phone:918-418-1825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization