Provider Demographics
NPI:1790593614
Name:PHASE2 LABS MISSISSIPPI LLC
Entity type:Organization
Organization Name:PHASE2 LABS MISSISSIPPI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRENTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-268-7093
Mailing Address - Street 1:5225 HARDING PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2901
Mailing Address - Country:US
Mailing Address - Phone:615-268-7093
Mailing Address - Fax:
Practice Address - Street 1:8727 NORTHWEST DR STE C
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-2429
Practice Address - Country:US
Practice Address - Phone:615-367-1208
Practice Address - Fax:615-327-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory