Provider Demographics
NPI:1154030765
Name:MAKO LABORATORY SERVICES LLC
Entity type:Organization
Organization Name:MAKO LABORATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-439-2203
Mailing Address - Street 1:729 S NEOSHO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850
Mailing Address - Country:US
Mailing Address - Phone:417-346-1400
Mailing Address - Fax:417-346-1401
Practice Address - Street 1:729 S NEOSHO BLVD
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-6485
Practice Address - Country:US
Practice Address - Phone:417-346-1400
Practice Address - Fax:417-346-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory