Provider Demographics
NPI:1215930987
Name:DIAGNOSTIC LABORATORY SERVICES, INC
Entity type:Organization
Organization Name:DIAGNOSTIC LABORATORY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-589-5175
Mailing Address - Street 1:99-859 IWAIWA ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3267
Mailing Address - Country:US
Mailing Address - Phone:808-589-5107
Mailing Address - Fax:808-589-5233
Practice Address - Street 1:99-859 IWAIWA ST
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3267
Practice Address - Country:US
Practice Address - Phone:808-589-5107
Practice Address - Fax:808-589-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI22053OtherHMSA
HI01999701Medicaid
HI01999701Medicaid