Provider Demographics
NPI:1306508932
Name:LOVING CARE SUPERIOR LAB
Entity type:Organization
Organization Name:LOVING CARE SUPERIOR LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUMPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-547-9349
Mailing Address - Street 1:13427 WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5508
Mailing Address - Country:US
Mailing Address - Phone:228-547-9349
Mailing Address - Fax:
Practice Address - Street 1:13427 WINDSONG DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-5508
Practice Address - Country:US
Practice Address - Phone:228-547-9349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory