Provider Demographics
NPI:1477332997
Name:FIRST SOURCE TESTING LLC
Entity type:Organization
Organization Name:FIRST SOURCE TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-535-4020
Mailing Address - Street 1:3076 PALISADES CT STE D
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3452
Mailing Address - Country:US
Mailing Address - Phone:205-886-8075
Mailing Address - Fax:205-710-5595
Practice Address - Street 1:3076 PALISADES CT STE D
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-3452
Practice Address - Country:US
Practice Address - Phone:205-886-8075
Practice Address - Fax:205-710-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory