Provider Demographics
NPI:1952846339
Name:XPRESS CLINICAL LABS LLC
Entity Type:Organization
Organization Name:XPRESS CLINICAL LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-967-4710
Mailing Address - Street 1:906 W ROOSEVELT ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-2106
Mailing Address - Country:US
Mailing Address - Phone:615-967-4710
Mailing Address - Fax:
Practice Address - Street 1:906 W ROOSEVELT ST
Practice Address - Street 2:UNIT B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-2106
Practice Address - Country:US
Practice Address - Phone:615-967-4710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory