Provider Demographics
NPI:1861011447
Name:MEDLABS EXPRESS,INC
Entity Type:Organization
Organization Name:MEDLABS EXPRESS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:GHREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-447-4758
Mailing Address - Street 1:2208A BONAVENTURE CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3374
Mailing Address - Country:US
Mailing Address - Phone:318-447-4758
Mailing Address - Fax:318-230-7073
Practice Address - Street 1:2208A BONAVENTURE CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3374
Practice Address - Country:US
Practice Address - Phone:318-447-4758
Practice Address - Fax:318-230-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1234Medicaid