Provider Demographics
NPI:1750032884
Name:PROLABS OF NC,LLC
Entity Type:Organization
Organization Name:PROLABS OF NC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-672-5592
Mailing Address - Street 1:6 CONSULTANT PL STE 200
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3598
Mailing Address - Country:US
Mailing Address - Phone:919-672-5592
Mailing Address - Fax:919-573-0937
Practice Address - Street 1:6 CONSULTANT PL STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3598
Practice Address - Country:US
Practice Address - Phone:919-672-5592
Practice Address - Fax:919-573-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory