Provider Demographics
NPI:1942924303
Name:VIP LABS LLC
Entity Type:Organization
Organization Name:VIP LABS LLC
Other - Org Name:VIP LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-546-4503
Mailing Address - Street 1:722 W EXCHANGE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2065
Mailing Address - Country:US
Mailing Address - Phone:708-852-3171
Mailing Address - Fax:708-852-3211
Practice Address - Street 1:402B UPTOWN SQUARE
Practice Address - Street 2:UNIT 2
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:901-546-4503
Practice Address - Fax:901-546-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory