Provider Demographics
NPI:1205890522
Name:LOOKADOO SKYLINE LABORATORY INC
Entity type:Organization
Organization Name:LOOKADOO SKYLINE LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J.D.
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOKADOO
Authorized Official - Suffix:
Authorized Official - Credentials:MT LAB DIRECTOR
Authorized Official - Phone:772-337-4504
Mailing Address - Street 1:1801 SE HILLMOOR DR
Mailing Address - Street 2:SUITE C-101
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7553
Mailing Address - Country:US
Mailing Address - Phone:772-337-4504
Mailing Address - Fax:772-335-8983
Practice Address - Street 1:1801 SE HILLMOOR DR
Practice Address - Street 2:SUITE C-101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7553
Practice Address - Country:US
Practice Address - Phone:772-337-4504
Practice Address - Fax:772-335-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========003OtherTRICARE
FLL8094Medicare ID - Type UnspecifiedINDEPENDENT LABORATORY