Provider Demographics
NPI:1487657573
Name:INTEGRATED REGIONAL LABORATORIES, LLP
Entity Type:Organization
Organization Name:INTEGRATED REGIONAL LABORATORIES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-777-0018
Mailing Address - Street 1:3201 SW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-8157
Mailing Address - Country:US
Mailing Address - Phone:954-777-0018
Mailing Address - Fax:866-772-5953
Practice Address - Street 1:3201 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-8157
Practice Address - Country:US
Practice Address - Phone:954-777-0018
Practice Address - Fax:866-772-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D0964885291U00000X
FL291U00000X
FL10D-0964885291U00000X
FL800014878291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL9208OtherBLUE SHIELD
FL030661400Medicaid
FL=========OtherTAX ID EIN
FLL9208OtherBLUE SHIELD