Provider Demographics
NPI:1508307562
Name:NEUSCIENCE LABORATORY LLC
Entity Type:Organization
Organization Name:NEUSCIENCE LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-343-0010
Mailing Address - Street 1:25 AIRPARK CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6188
Mailing Address - Country:US
Mailing Address - Phone:864-343-0010
Mailing Address - Fax:864-312-6927
Practice Address - Street 1:25 AIRPARK CT
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6188
Practice Address - Country:US
Practice Address - Phone:864-343-0010
Practice Address - Fax:864-312-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory