Provider Demographics
NPI:1922723568
Name:ONE LOVE PERIODIC SERVICES INC
Entity Type:Organization
Organization Name:ONE LOVE PERIODIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-510-4286
Mailing Address - Street 1:4922 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6618
Mailing Address - Country:US
Mailing Address - Phone:704-510-4286
Mailing Address - Fax:866-577-8515
Practice Address - Street 1:4922 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6618
Practice Address - Country:US
Practice Address - Phone:704-510-4286
Practice Address - Fax:866-577-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory