Provider Demographics
NPI:1568714830
Name:MEGAN MEDICAL LAB COLLECTION CENTER
Entity Type:Organization
Organization Name:MEGAN MEDICAL LAB COLLECTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-364-4945
Mailing Address - Street 1:1275 W 47TH PL
Mailing Address - Street 2:SUITE 434
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1275 W 47TH PL
Practice Address - Street 2:SUITE 434
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3394
Practice Address - Country:US
Practice Address - Phone:305-364-4945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory