Provider Demographics
NPI:1962804088
Name:SKIPPACK MEDICAL LAB, LLC
Entity type:Organization
Organization Name:SKIPPACK MEDICAL LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AABEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-584-1669
Mailing Address - Street 1:200 RITTENHOUSE CIR UNIT 9
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-1619
Mailing Address - Country:US
Mailing Address - Phone:610-584-1669
Mailing Address - Fax:
Practice Address - Street 1:200 RITTENHOUSE CIRCLE EAST
Practice Address - Street 2:SUITE 9
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-1619
Practice Address - Country:US
Practice Address - Phone:610-584-1669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036594640001Medicaid