Provider Demographics
NPI:1679257703
Name:MEDICHECK LABS, LLC
Entity Type:Organization
Organization Name:MEDICHECK LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:TAZAMEAR
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:601-549-0710
Mailing Address - Street 1:4658 PRESIDENTIAL PKWY # 1533
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-8708
Mailing Address - Country:US
Mailing Address - Phone:800-513-1835
Mailing Address - Fax:
Practice Address - Street 1:5578 RIVERSIDE DR APT 115
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-8860
Practice Address - Country:US
Practice Address - Phone:800-513-1835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No291U00000XLaboratoriesClinical Medical Laboratory
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment