Provider Demographics
NPI:1598231045
Name:NATIONWIDE LABORATORIES, LLC
Entity Type:Organization
Organization Name:NATIONWIDE LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-593-8601
Mailing Address - Street 1:1307 ALLEN DR STE A300
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4000
Mailing Address - Country:US
Mailing Address - Phone:855-698-2941
Mailing Address - Fax:888-392-6043
Practice Address - Street 1:1307 ALLEN DR STE A300
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4000
Practice Address - Country:US
Practice Address - Phone:855-698-2941
Practice Address - Fax:888-392-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory