Provider Demographics
NPI:1912514407
Name:GLOBAL LAB
Entity Type:Organization
Organization Name:GLOBAL LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-732-3713
Mailing Address - Street 1:4374 STUD HOSS RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71229-8973
Mailing Address - Country:US
Mailing Address - Phone:318-732-3713
Mailing Address - Fax:
Practice Address - Street 1:201 CENTURY VILLAGE BLVD STE 226
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2008
Practice Address - Country:US
Practice Address - Phone:318-732-3713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory