Provider Demographics
NPI:1013502681
Name:GOLAB
Entity Type:Organization
Organization Name:GOLAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-800-3512
Mailing Address - Street 1:4701 SW ADMIRAL WAY STE 8
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4701 SW ADMIRAL WAY STE 8
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2340
Practice Address - Country:US
Practice Address - Phone:206-800-3512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory