Provider Demographics
NPI:1821376294
Name:GO LABS
Entity Type:Organization
Organization Name:GO LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHLEBOTOMIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOYA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SPROUL
Authorized Official - Suffix:
Authorized Official - Credentials:GEN PTR, PBT
Authorized Official - Phone:224-789-8076
Mailing Address - Street 1:4106 PHILLIP DR
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-9204
Mailing Address - Country:US
Mailing Address - Phone:224-789-8076
Mailing Address - Fax:928-222-3678
Practice Address - Street 1:4106 PHILLIP DR
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-9204
Practice Address - Country:US
Practice Address - Phone:224-789-8076
Practice Address - Fax:928-222-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory