Provider Demographics
NPI:1740747849
Name:220 LAB GROUP LLC
Entity Type:Organization
Organization Name:220 LAB GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE EMIL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-234-9446
Mailing Address - Street 1:22505 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2161
Mailing Address - Country:US
Mailing Address - Phone:623-234-9446
Mailing Address - Fax:623-234-9448
Practice Address - Street 1:22505 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2161
Practice Address - Country:US
Practice Address - Phone:623-234-9446
Practice Address - Fax:623-234-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory