Provider Demographics
NPI:1750835278
Name:G. CROSS MEDICAL LABS, LLC
Entity Type:Organization
Organization Name:G. CROSS MEDICAL LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KALLUPURA
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:781-864-1391
Mailing Address - Street 1:17945 HUNTING BOW CIR
Mailing Address - Street 2:#101
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5376
Mailing Address - Country:US
Mailing Address - Phone:781-864-1391
Mailing Address - Fax:
Practice Address - Street 1:2901 N DALE MABRY HWY
Practice Address - Street 2:#612
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2412
Practice Address - Country:US
Practice Address - Phone:781-864-1391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2097893291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory