Provider Demographics
NPI:1548279227
Name:UNITED LABORATORY SERVICE,CORP
Entity type:Organization
Organization Name:UNITED LABORATORY SERVICE,CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDALMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAIDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-269-0121
Mailing Address - Street 1:7095 SW 47 STREET
Mailing Address - Street 2:STE B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:305-269-0121
Mailing Address - Fax:305-269-4941
Practice Address - Street 1:7095 SW 47TH ST BLDG B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4653
Practice Address - Country:US
Practice Address - Phone:305-269-0121
Practice Address - Fax:305-269-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800020757291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032188500Medicaid
FL032188500Medicaid
FLE9175Medicare UPIN