Provider Demographics
NPI:1306240171
Name:TOTAL LAB CARE LLC
Entity type:Organization
Organization Name:TOTAL LAB CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-647-7404
Mailing Address - Street 1:7685 103RD ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-9325
Mailing Address - Country:US
Mailing Address - Phone:904-647-7404
Mailing Address - Fax:904-394-5115
Practice Address - Street 1:7685 103RD ST
Practice Address - Street 2:SUITE A1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-9325
Practice Address - Country:US
Practice Address - Phone:904-647-7404
Practice Address - Fax:904-394-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800027316291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2077557OtherCLIA ID NUMBER
FL800027316OtherACHA LICENSE