Provider Demographics
NPI:1871821124
Name:IYM SERVICES LLC
Entity Type:Organization
Organization Name:IYM SERVICES LLC
Other - Org Name:CLINICAL LABORATORY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IBTIHAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:AWADELKARIEM
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:571-313-0542
Mailing Address - Street 1:46440 BENEDICT DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-6602
Mailing Address - Country:US
Mailing Address - Phone:571-313-0542
Mailing Address - Fax:571-313-0556
Practice Address - Street 1:46440 BENEDICT DR
Practice Address - Street 2:SUITE 104
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6602
Practice Address - Country:US
Practice Address - Phone:571-313-0542
Practice Address - Fax:571-313-0556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IYM SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-25
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)