Provider Demographics
NPI:1578940516
Name:LCMS LABORATORIES INC.
Entity Type:Organization
Organization Name:LCMS LABORATORIES INC.
Other - Org Name:LCMS LABORATORIES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGTHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-456-2900
Mailing Address - Street 1:10831 N MAVINEE DR
Mailing Address - Street 2:SUITE 165
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9530
Mailing Address - Country:US
Mailing Address - Phone:858-456-2900
Mailing Address - Fax:866-732-9564
Practice Address - Street 1:10831 N MAVINEE DR
Practice Address - Street 2:SUITE 165
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9530
Practice Address - Country:US
Practice Address - Phone:858-456-2900
Practice Address - Fax:866-732-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3771291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory