Provider Demographics
NPI:1780096180
Name:EZ TUBZ LLC
Entity type:Organization
Organization Name:EZ TUBZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSHON
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BLAKEY
Authorized Official - Suffix:
Authorized Official - Credentials:COUNSEL
Authorized Official - Phone:502-290-5248
Mailing Address - Street 1:2207 CRUMS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4253
Mailing Address - Country:US
Mailing Address - Phone:502-290-5248
Mailing Address - Fax:
Practice Address - Street 1:2207 CRUMS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4253
Practice Address - Country:US
Practice Address - Phone:502-290-5248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization