Provider Demographics
NPI:1598425076
Name:MAGGIES LAB CAB, LLC
Entity Type:Organization
Organization Name:MAGGIES LAB CAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KYER
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED NP
Authorized Official - Phone:928-230-5789
Mailing Address - Street 1:60 ACOMA BLVD S STE A100
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5998
Mailing Address - Country:US
Mailing Address - Phone:928-486-3989
Mailing Address - Fax:
Practice Address - Street 1:60 ACOMA BLVD S STE A100
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5998
Practice Address - Country:US
Practice Address - Phone:928-486-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty