Provider Demographics
NPI:1013679992
Name:JUSTKAM QUICK STICK LAB
Entity Type:Organization
Organization Name:JUSTKAM QUICK STICK LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-260-7990
Mailing Address - Street 1:1235 W HILLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6911
Mailing Address - Country:US
Mailing Address - Phone:510-593-9110
Mailing Address - Fax:
Practice Address - Street 1:1235 W HILLSBORO ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6911
Practice Address - Country:US
Practice Address - Phone:510-593-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty