Provider Demographics
NPI:1205498383
Name:INTELEX LABS LLC
Entity type:Organization
Organization Name:INTELEX LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-570-5852
Mailing Address - Street 1:1645 PALM BEACH LAKES BLVD STE 1010
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2218
Mailing Address - Country:US
Mailing Address - Phone:304-657-9011
Mailing Address - Fax:
Practice Address - Street 1:7859 SW ELLIPSE WAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7247
Practice Address - Country:US
Practice Address - Phone:304-657-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory