Provider Demographics
NPI:1306170329
Name:MED QUIK LABS LLC
Entity type:Organization
Organization Name:MED QUIK LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-850-1348
Mailing Address - Street 1:PO BOX 3703
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3703
Mailing Address - Country:US
Mailing Address - Phone:417-206-7845
Mailing Address - Fax:417-782-6331
Practice Address - Street 1:101 N RANGE LINE RD STE 322
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-4118
Practice Address - Country:US
Practice Address - Phone:417-206-7845
Practice Address - Fax:417-782-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory