Provider Demographics
NPI:1457952855
Name:BOSTON LABS
Entity Type:Organization
Organization Name:BOSTON LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-307-0287
Mailing Address - Street 1:629 LAKELAND EAST DR STE D
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8926
Mailing Address - Country:US
Mailing Address - Phone:601-307-0287
Mailing Address - Fax:
Practice Address - Street 1:629 LAKELAND EAST DR STE D
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8926
Practice Address - Country:US
Practice Address - Phone:601-307-0287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory