Provider Demographics
NPI:1013283365
Name:MED LAB SERVICES, LLC
Entity Type:Organization
Organization Name:MED LAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-789-6810
Mailing Address - Street 1:3855 E SILVER SPRINGS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-4929
Mailing Address - Country:US
Mailing Address - Phone:352-789-6810
Mailing Address - Fax:352-789-6820
Practice Address - Street 1:3855 E SILVER SPRINGS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4929
Practice Address - Country:US
Practice Address - Phone:352-789-6810
Practice Address - Fax:352-789-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA41977291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory