Provider Demographics
NPI:1851895304
Name:EXPRESS LAB OF OCALA LLC
Entity Type:Organization
Organization Name:EXPRESS LAB OF OCALA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLAVENTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-620-5588
Mailing Address - Street 1:6600 SW HIGHWAY 200 STE 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-5554
Mailing Address - Country:US
Mailing Address - Phone:352-237-4116
Mailing Address - Fax:
Practice Address - Street 1:6600 SW HIGHWAY 200 STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-5554
Practice Address - Country:US
Practice Address - Phone:352-237-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory