Provider Demographics
NPI:1356645295
Name:INFINITI LABS, INC
Entity type:Organization
Organization Name:INFINITI LABS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-886-2616
Mailing Address - Street 1:6015 BENJAMIN RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5179
Mailing Address - Country:US
Mailing Address - Phone:813-886-2616
Mailing Address - Fax:813-886-2735
Practice Address - Street 1:6015 BENJAMIN RD
Practice Address - Street 2:SUITE 315
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5179
Practice Address - Country:US
Practice Address - Phone:813-453-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800026057291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory