Basic Information
| Provider Information | |||||||||
| NPI: | 1891822771 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LABWORKS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASSURANCE LABORATORIES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 639 | ||||||||
| Address2: | |||||||||
| City: | THIENSVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530920639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142479005 | ||||||||
| FaxNumber: | 4142479004 | ||||||||
| Practice Location | |||||||||
| Address1: | 1630 B MILLER PARK WAY | ||||||||
| Address2: | |||||||||
| City: | WEST MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532143604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142483601 | ||||||||
| FaxNumber: | 4144479891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 11/01/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | OBOYLE | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4142483601 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 52D1031844 | WI | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 32816000 | 05 | WI | MEDICAID | 000083205 | 01 | WI | MEDICARE | OTHER |