Provider Demographics
NPI:1699287300
Name:METRIC LAB SERVICES LLC
Entity type:Organization
Organization Name:METRIC LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-679-0388
Mailing Address - Street 1:PO BOX 95546
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76099-9703
Mailing Address - Country:US
Mailing Address - Phone:832-250-5335
Mailing Address - Fax:
Practice Address - Street 1:116 MARKETRIDGE DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-6009
Practice Address - Country:US
Practice Address - Phone:601-557-0204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25D2137603291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory