Provider Demographics
NPI:1689328387
Name:SLM LABS 2
Entity Type:Organization
Organization Name:SLM LABS 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON MCCRORY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:228-493-9784
Mailing Address - Street 1:547 SUNRISE RD
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-9654
Mailing Address - Country:US
Mailing Address - Phone:228-493-9784
Mailing Address - Fax:
Practice Address - Street 1:547 SUNRISE RD
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-9654
Practice Address - Country:US
Practice Address - Phone:228-493-9784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLM LABS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory