Provider Demographics
NPI:1508178625
Name:PREPAID LAB, LLC
Entity Type:Organization
Organization Name:PREPAID LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAWES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-930-7500
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-0171
Mailing Address - Country:US
Mailing Address - Phone:440-930-7500
Mailing Address - Fax:240-376-6325
Practice Address - Street 1:33479 LAKE RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1136
Practice Address - Country:US
Practice Address - Phone:440-930-7500
Practice Address - Fax:240-376-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045378291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory