Provider Demographics
NPI:1811654304
Name:A.C.T KWIK LAB LLC
Entity type:Organization
Organization Name:A.C.T KWIK LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:205-500-0177
Mailing Address - Street 1:11321 RAYNOR RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-7856
Mailing Address - Country:US
Mailing Address - Phone:205-500-0177
Mailing Address - Fax:888-758-4442
Practice Address - Street 1:11321 RAYNOR RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-7856
Practice Address - Country:US
Practice Address - Phone:205-500-0177
Practice Address - Fax:888-758-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory