1013243328 NPI number — SARAH'S LAB

Table of content: (NPI 1013243328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013243328 NPI number — SARAH'S LAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARAH'S LAB
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013243328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 N 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53094-3862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-215-2008
Provider Business Mailing Address Fax Number:
920-206-1666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 N. 4TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53094-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-215-2008
Provider Business Practice Location Address Fax Number:
920-206-1666
Provider Enumeration Date:
10/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KISER
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
920-215-2008

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  32001071959 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013243328 . This is a "CLINICAL MEDICAL LABORATORY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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