Provider Demographics
NPI:1912863713
Name:MF EXPRESS LAB AND VITALITY CENTER
Entity type:Organization
Organization Name:MF EXPRESS LAB AND VITALITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:980-437-4109
Mailing Address - Street 1:905 CASSIDY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4306
Mailing Address - Country:US
Mailing Address - Phone:980-925-5566
Mailing Address - Fax:888-830-7437
Practice Address - Street 1:16 OAK GROVE ST UNIT 8
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1655
Practice Address - Country:US
Practice Address - Phone:980-925-5566
Practice Address - Fax:888-830-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-25
Last Update Date:2025-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory