Provider Demographics
NPI:1134880347
Name:QUEOLOGY EXPRESS LABS LLC
Entity type:Organization
Organization Name:QUEOLOGY EXPRESS LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAQUISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-256-6789
Mailing Address - Street 1:14260 W NEWBERRY RD # 204
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2765
Mailing Address - Country:US
Mailing Address - Phone:352-256-6789
Mailing Address - Fax:
Practice Address - Street 1:414 SW 140TH TER
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3363
Practice Address - Country:US
Practice Address - Phone:352-256-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory