Provider Demographics
NPI:1306350194
Name:MEDICAL LABORATORY SERVICE INC
Entity type:Organization
Organization Name:MEDICAL LABORATORY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:IOCCA-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-206-7267
Mailing Address - Street 1:31700 W 13 MILE RD # 218
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2166
Mailing Address - Country:US
Mailing Address - Phone:248-907-3985
Mailing Address - Fax:
Practice Address - Street 1:2324 BROOKLYN RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-4750
Practice Address - Country:US
Practice Address - Phone:517-997-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory