Provider Demographics
NPI:1720361173
Name:LOGAN LABORATORIES, LLC
Entity Type:Organization
Organization Name:LOGAN LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-316-4824
Mailing Address - Street 1:5050 W LEMON ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1104
Mailing Address - Country:US
Mailing Address - Phone:813-514-1500
Mailing Address - Fax:
Practice Address - Street 1:5050 W LEMON ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1104
Practice Address - Country:US
Practice Address - Phone:813-316-4824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGERY CENTER HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-22
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory