Provider Demographics
NPI:1306655121
Name:ONTHEFLY LABS
Entity type:Organization
Organization Name:ONTHEFLY LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-453-0310
Mailing Address - Street 1:4364 WESTERN CENTER BLVD # 2114
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2043
Mailing Address - Country:US
Mailing Address - Phone:682-453-0310
Mailing Address - Fax:
Practice Address - Street 1:4364 WESTERN CENTER BLVD # 2114
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2043
Practice Address - Country:US
Practice Address - Phone:682-453-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory