Provider Demographics
NPI:1184964728
Name:U S LAB & RADIOLOGY LLC.
Entity type:Organization
Organization Name:U S LAB & RADIOLOGY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-940-0389
Mailing Address - Street 1:2 JONATHAN DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5549
Mailing Address - Country:US
Mailing Address - Phone:508-583-2000
Mailing Address - Fax:
Practice Address - Street 1:21455 MELROSE AVE
Practice Address - Street 2:BLDG R, SUITE 13
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7980
Practice Address - Country:US
Practice Address - Phone:800-786-8015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory