Provider Demographics
NPI:1194558593
Name:FAST LABS MOBILE LAB SERVICES LLC
Entity type:Organization
Organization Name:FAST LABS MOBILE LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REISEN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:512-638-9149
Mailing Address - Street 1:1436 CASTALO LN
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4530
Mailing Address - Country:US
Mailing Address - Phone:512-638-9149
Mailing Address - Fax:512-857-4545
Practice Address - Street 1:1436 CASTALO LN
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-4530
Practice Address - Country:US
Practice Address - Phone:512-638-9149
Practice Address - Fax:512-857-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory