Provider Demographics
NPI:1295486256
Name:BIG BUS LABS LLC
Entity type:Organization
Organization Name:BIG BUS LABS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MANIKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:520-279-3099
Mailing Address - Street 1:625 W MCKELLIPS RD LOT 170
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-1256
Mailing Address - Country:US
Mailing Address - Phone:520-279-3099
Mailing Address - Fax:
Practice Address - Street 1:625 W MCKELLIPS RD LOT 170
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-1256
Practice Address - Country:US
Practice Address - Phone:520-279-3099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy