Provider Demographics
NPI:1699403303
Name:GPOWELL LLC
Entity type:Organization
Organization Name:GPOWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENROY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LAB DICTOR
Authorized Official - Phone:954-864-0841
Mailing Address - Street 1:1785 NE 162ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4757
Mailing Address - Country:US
Mailing Address - Phone:954-864-0841
Mailing Address - Fax:
Practice Address - Street 1:1785 NE 162ND ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4757
Practice Address - Country:US
Practice Address - Phone:954-864-0841
Practice Address - Fax:
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