Provider Demographics
NPI:1477204980
Name:LOTUS LABS LLC
Entity type:Organization
Organization Name:LOTUS LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:CHARITY
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:757-438-7004
Mailing Address - Street 1:11747 JEFFERSON AVE STE 6C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1998
Mailing Address - Country:US
Mailing Address - Phone:757-438-7004
Mailing Address - Fax:
Practice Address - Street 1:33 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2434
Practice Address - Country:US
Practice Address - Phone:757-438-7004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902314651Medicaid