Provider Demographics
NPI:1184359143
Name:MY LAB
Entity type:Organization
Organization Name:MY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HAMPTON
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-756-3460
Mailing Address - Street 1:808 HIGHWAY 378 STE B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8379
Mailing Address - Country:US
Mailing Address - Phone:803-756-3460
Mailing Address - Fax:803-756-3461
Practice Address - Street 1:808 HIGHWAY 378 STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8379
Practice Address - Country:US
Practice Address - Phone:803-756-3460
Practice Address - Fax:803-756-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC42D2265053OtherCLIA ID