Provider Demographics
NPI:1588392344
Name:MLIFE LABORATORIES LLC
Entity type:Organization
Organization Name:MLIFE LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUDERMILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-605-7300
Mailing Address - Street 1:511 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-2007
Mailing Address - Country:US
Mailing Address - Phone:408-605-7300
Mailing Address - Fax:877-347-8075
Practice Address - Street 1:8313 SOUTHWEST FWY STE 321
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1656
Practice Address - Country:US
Practice Address - Phone:832-653-2894
Practice Address - Fax:832-653-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory