Provider Demographics
NPI:1174384358
Name:TEST EASY LABORATORY
Entity type:Organization
Organization Name:TEST EASY LABORATORY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PORSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNGO-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-286-7157
Mailing Address - Street 1:1499 LYNWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-0964
Mailing Address - Country:US
Mailing Address - Phone:803-286-7157
Mailing Address - Fax:
Practice Address - Street 1:1499 LYNWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-0964
Practice Address - Country:US
Practice Address - Phone:803-286-7157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty
No246QH0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHematologyGroup - Multi-Specialty
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory ManagementGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)