Provider Demographics
NPI:1841546678
Name:UNIFIED LABORATORY SERVICES LLC
Entity type:Organization
Organization Name:UNIFIED LABORATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-993-9857
Mailing Address - Street 1:512 N HAMPTON RD
Mailing Address - Street 2:STE 261
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4920
Mailing Address - Country:US
Mailing Address - Phone:817-993-9857
Mailing Address - Fax:817-294-4987
Practice Address - Street 1:6116 OAKBEND TRL
Practice Address - Street 2:STE 106
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3925
Practice Address - Country:US
Practice Address - Phone:817-993-9857
Practice Address - Fax:817-294-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory