Provider Demographics
NPI:1578960274
Name:DIRECT ACCESS LAB, LLC
Entity Type:Organization
Organization Name:DIRECT ACCESS LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-315-8277
Mailing Address - Street 1:1940 S MINT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4629
Mailing Address - Country:US
Mailing Address - Phone:704-315-8277
Mailing Address - Fax:704-379-1824
Practice Address - Street 1:4822 ALBEMARLE ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6621
Practice Address - Country:US
Practice Address - Phone:704-631-9934
Practice Address - Fax:704-379-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34D2082931291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory