Provider Demographics
NPI:1497354575
Name:LIFETECH SCIENCES LLC
Entity type:Organization
Organization Name:LIFETECH SCIENCES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-MURRANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:913-909-1128
Mailing Address - Street 1:1440 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66609-1208
Mailing Address - Country:US
Mailing Address - Phone:913-909-1128
Mailing Address - Fax:800-859-9507
Practice Address - Street 1:3711A SW WANAMAKER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66610-1368
Practice Address - Country:US
Practice Address - Phone:785-224-4775
Practice Address - Fax:800-859-9507
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFETECH SCIENCES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004729180001Medicaid