Provider Demographics
NPI:1407466253
Name:VAN LAAN INDUSTRIES INC.
Entity Type:Organization
Organization Name:VAN LAAN INDUSTRIES INC.
Other - Org Name:TESTSOURCE LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN LAAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-216-3668
Mailing Address - Street 1:3414 LOVERS LN STE A
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4806
Mailing Address - Country:US
Mailing Address - Phone:269-216-3668
Mailing Address - Fax:269-216-3668
Practice Address - Street 1:3414 LOVERS LN STE A
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4806
Practice Address - Country:US
Practice Address - Phone:269-216-3668
Practice Address - Fax:269-216-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory