Provider Demographics
NPI:1912251778
Name:SLS OF TAMPA BAY, INC.
Entity Type:Organization
Organization Name:SLS OF TAMPA BAY, INC.
Other - Org Name:SUPERIOR LAB SERVICES OF TAMPA BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-551-2011
Mailing Address - Street 1:735 ARLINGTON AVENUE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-551-2011
Mailing Address - Fax:727-821-6029
Practice Address - Street 1:735 ARLINGTON AVENUE
Practice Address - Street 2:SUITE 112
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3653
Practice Address - Country:US
Practice Address - Phone:727-551-2011
Practice Address - Fax:727-821-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL010655CPT246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty