Provider Demographics
NPI:1265198857
Name:P23 LABS, LLC
Entity type:Organization
Organization Name:P23 LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-567-3348
Mailing Address - Street 1:CENTRO INTERNACIONAL DE MERCADEO 100 CARR 165
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00964-8049
Mailing Address - Country:US
Mailing Address - Phone:901-341-6464
Mailing Address - Fax:
Practice Address - Street 1:CENTRO INTERNACIONAL DE MERCADEO 100 CARR 165
Practice Address - Street 2:SUITE 304
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00964-8049
Practice Address - Country:US
Practice Address - Phone:901-341-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory