Provider Demographics
NPI:1134870090
Name:SECURED LAB SERVICES, LLC
Entity type:Organization
Organization Name:SECURED LAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:SIDDIQU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-718-8384
Mailing Address - Street 1:5700 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3328
Mailing Address - Country:US
Mailing Address - Phone:501-227-0184
Mailing Address - Fax:501-251-1971
Practice Address - Street 1:5700 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3328
Practice Address - Country:US
Practice Address - Phone:501-227-0184
Practice Address - Fax:501-251-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory