Provider Demographics
NPI:1437903911
Name:SECURE LABS LLC
Entity Type:Organization
Organization Name:SECURE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHATONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:800-356-6021
Mailing Address - Street 1:850 S 21ST ST STE M
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4846
Mailing Address - Country:US
Mailing Address - Phone:754-215-6822
Mailing Address - Fax:
Practice Address - Street 1:850 S 21ST ST STE M
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4846
Practice Address - Country:US
Practice Address - Phone:754-215-6822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty