Provider Demographics
NPI:1922852169
Name:SYNERGY DIAGNOSTIC LAB LLC
Entity Type:Organization
Organization Name:SYNERGY DIAGNOSTIC LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-833-5025
Mailing Address - Street 1:100 SHADOW OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-6046
Mailing Address - Country:US
Mailing Address - Phone:501-833-5025
Mailing Address - Fax:
Practice Address - Street 1:100 SHADOW OAKS DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-6046
Practice Address - Country:US
Practice Address - Phone:501-833-5025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory