Provider Demographics
NPI:1497175905
Name:ISPM LABS, LLC
Entity Type:Organization
Organization Name:ISPM LABS, LLC
Other - Org Name:CAPSTONE DIAGNOSTICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-515-4524
Mailing Address - Street 1:PO BOX 743943
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3943
Mailing Address - Country:US
Mailing Address - Phone:678-515-4524
Mailing Address - Fax:
Practice Address - Street 1:8601 DUNWOODY PL STE 444
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350
Practice Address - Country:US
Practice Address - Phone:678-515-4524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11D2073885OtherCLIA