Provider Demographics
NPI:1437882164
Name:SRG HEALTH LABS LLC
Entity Type:Organization
Organization Name:SRG HEALTH LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SADECA
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-471-4127
Mailing Address - Street 1:2317 INTERNATIONAL LN STE 114
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3154
Mailing Address - Country:US
Mailing Address - Phone:608-471-4127
Mailing Address - Fax:
Practice Address - Street 1:2317 INTERNATIONAL LN STE 114
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3154
Practice Address - Country:US
Practice Address - Phone:608-471-4127
Practice Address - Fax:855-316-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-09
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty