Provider Demographics
NPI:1841943834
Name:STAT LAB TESTING
Entity type:Organization
Organization Name:STAT LAB TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-830-5751
Mailing Address - Street 1:1502 SUMMIT OAK CT APT A
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-6236
Mailing Address - Country:US
Mailing Address - Phone:269-830-5751
Mailing Address - Fax:
Practice Address - Street 1:1502 SUMMIT OAK CT APT A
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-6236
Practice Address - Country:US
Practice Address - Phone:269-830-5751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory