Provider Demographics
NPI:1952348757
Name:RX INNOVATIONS, LLC, DBA FIRSTLAB OF VIRGINIA
Entity Type:Organization
Organization Name:RX INNOVATIONS, LLC, DBA FIRSTLAB OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS MT(ASCP)
Authorized Official - Phone:757-412-3273
Mailing Address - Street 1:1701 WILL O WISP DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3102
Mailing Address - Country:US
Mailing Address - Phone:757-412-3273
Mailing Address - Fax:757-412-6464
Practice Address - Street 1:1701 WILL O WISP DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3102
Practice Address - Country:US
Practice Address - Phone:757-412-3273
Practice Address - Fax:757-412-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2005-108709-R291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017147150004Medicaid
NJ0081027Medicaid
WV3810001231Medicaid
VA145016OtherANTHEM BC/BS
DE1000038465Medicaid
NE100251695-00Medicaid
ALLB872VAMedicaid
DE1000038465Medicaid