Provider Demographics
NPI:1386116846
Name:PHI LIFE SCIENCES LLC
Entity type:Organization
Organization Name:PHI LIFE SCIENCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:888-576-5445
Mailing Address - Street 1:645 MEETING ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-4277
Mailing Address - Country:US
Mailing Address - Phone:888-576-5445
Mailing Address - Fax:843-724-3480
Practice Address - Street 1:4701 MELBOURNE PL STE A2
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-2540
Practice Address - Country:US
Practice Address - Phone:888-576-5445
Practice Address - Fax:888-738-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21D2158103OtherCLIA