Provider Demographics
NPI:1457136020
Name:QUICK TEST LAB FLORIDA LLC
Entity Type:Organization
Organization Name:QUICK TEST LAB FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-784-5522
Mailing Address - Street 1:6300 NW EXPRESSWAY STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5128
Mailing Address - Country:US
Mailing Address - Phone:866-784-5522
Mailing Address - Fax:
Practice Address - Street 1:5575 S SEMORAN BLVD STE 38
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1782
Practice Address - Country:US
Practice Address - Phone:866-784-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory