Provider Demographics
NPI:1447592308
Name:RADEAS LLC
Entity Type:Organization
Organization Name:RADEAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NRCC
Authorized Official - Phone:919-249-8378
Mailing Address - Street 1:907 GATEWAY COMMONS CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5993
Mailing Address - Country:US
Mailing Address - Phone:919-263-1150
Mailing Address - Fax:919-516-0096
Practice Address - Street 1:907 GATEWAY COMMONS CIR STE 100
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-263-1150
Practice Address - Fax:919-516-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOLAID: 24402291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory