Provider Demographics
NPI:1841883139
Name:META LAB DX LLC
Entity type:Organization
Organization Name:META LAB DX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAROL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-833-0489
Mailing Address - Street 1:9731 SOUTHERN PINE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5542
Mailing Address - Country:US
Mailing Address - Phone:980-265-8157
Mailing Address - Fax:
Practice Address - Street 1:9731 SOUTHERN PINE BLVD STE J
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5542
Practice Address - Country:US
Practice Address - Phone:980-265-8157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory