Lab704 LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LAB704 LLC

Practice address

110 Stockton St # E4
Statesville, NC 28677-5253

Phone

(315) 289-6165

NPI assigned

Jan 21, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Latasha G Aiken

Title

LPN

Phone

(315) 289-6165

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642723200000",
    "number": "1942952908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CLODFELTER RD",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281157810",
            "telephone_number": "315-289-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 STOCKTON ST # E4",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286775253",
            "telephone_number": "315-289-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAB704 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-21",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A",
        "authorized_official_last_name": "AIKEN",
        "authorized_official_first_name": "LATASHA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "LPN",
        "authorized_official_telephone_number": "315-289-6165"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Statesville, NC
• Providers in Statesville, NC by specialty
• Clinical Medical Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.