Provider Demographics
NPI:1760077606
Name:PHASE2 LABS, LLC
Entity Type:Organization
Organization Name:PHASE2 LABS, LLC
Other - Org Name:PHASETWO LABS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-838-4444
Mailing Address - Street 1:5225 HARDING PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2901
Mailing Address - Country:US
Mailing Address - Phone:615-367-1208
Mailing Address - Fax:
Practice Address - Street 1:5225 HARDING PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2901
Practice Address - Country:US
Practice Address - Phone:629-777-4902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory