Provider Demographics
NPI:1285447623
Name:CRANE CREEK LAB LLC
Entity type:Organization
Organization Name:CRANE CREEK LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-586-6973
Mailing Address - Street 1:1600 SARNO RD STE 10
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4992
Mailing Address - Country:US
Mailing Address - Phone:904-586-6973
Mailing Address - Fax:321-334-6515
Practice Address - Street 1:1600 SARNO RD STE 10
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4992
Practice Address - Country:US
Practice Address - Phone:904-586-6973
Practice Address - Fax:321-334-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory