Provider Demographics
NPI:1740048537
Name:4K PLUS 1 DIAGNOSTIC LAB CENTER
Entity type:Organization
Organization Name:4K PLUS 1 DIAGNOSTIC LAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:205-567-6101
Mailing Address - Street 1:7255 TIMBER LEAF BR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-3619
Mailing Address - Country:US
Mailing Address - Phone:205-567-6101
Mailing Address - Fax:
Practice Address - Street 1:7255 TIMBER LEAF BR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-3619
Practice Address - Country:US
Practice Address - Phone:205-567-6101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service