Provider Demographics
NPI:1578040630
Name:INVICTA LABORATORIES LLC
Entity Type:Organization
Organization Name:INVICTA LABORATORIES LLC
Other - Org Name:NAUTIC MEDICAL LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOGANATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORAISAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-472-5590
Mailing Address - Street 1:312 NANCY LYNN LN STE 2
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6046
Mailing Address - Country:US
Mailing Address - Phone:865-985-0945
Mailing Address - Fax:865-312-9662
Practice Address - Street 1:312 NANCY LYNN LN STE 2
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6046
Practice Address - Country:US
Practice Address - Phone:865-776-6258
Practice Address - Fax:865-312-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-22
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory