Provider Demographics
NPI:1841638608
Name:ADVANCED LABORATORY SERVICES, INC.
Entity type:Organization
Organization Name:ADVANCED LABORATORY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:N
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-864-8181
Mailing Address - Street 1:PO BOX 5312
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21094-5312
Mailing Address - Country:US
Mailing Address - Phone:410-864-8181
Mailing Address - Fax:410-864-8149
Practice Address - Street 1:1498 REISTERSTOWN RD
Practice Address - Street 2:#207
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3817
Practice Address - Country:US
Practice Address - Phone:410-864-8181
Practice Address - Fax:410-864-8149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED LABORATORY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-13
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251K00000X
MD00000000291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare