Basic Information
| Provider Information | |||||||||
| NPI: | 1356735476 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUALITY LAB LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5427 COMMERCIAL WAY | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346061110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525847452 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5427 COMMERCIAL WAY | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346061110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525847452 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2015 | ||||||||
| LastUpdateDate: | 03/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | BAIG | ||||||||
| AuthorizedOfficialFirstName: | MIRZA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3525847452 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 10D2090296 | FL | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 10D2090296 | 01 | FL | CLIA | OTHER |