Provider Demographics
NPI:1942444559
Name:DAYSTAR LABS HAPPY HEART SCREENING
Entity Type:Organization
Organization Name:DAYSTAR LABS HAPPY HEART SCREENING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WEISKIRCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-407-2831
Mailing Address - Street 1:2874 N MULE DEER WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7812
Mailing Address - Country:US
Mailing Address - Phone:208-407-2831
Mailing Address - Fax:208-887-2278
Practice Address - Street 1:2874 N MULE DEER WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7812
Practice Address - Country:US
Practice Address - Phone:208-407-2831
Practice Address - Fax:208-887-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP705291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory