Provider Demographics
NPI:1588349161
Name:90 MINUTE LABORATORY LLC
Entity type:Organization
Organization Name:90 MINUTE LABORATORY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-284-6117
Mailing Address - Street 1:11903 PANAMA CITY BEACH PKWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2621
Mailing Address - Country:US
Mailing Address - Phone:850-284-6117
Mailing Address - Fax:850-373-4930
Practice Address - Street 1:11903 PANAMA CITY BEACH PKWY # B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-2605
Practice Address - Country:US
Practice Address - Phone:850-353-0187
Practice Address - Fax:850-373-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory