Organization
SMART LAB LLC
Active
Other names
SMART Lab, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN MORGAN WAYNE (CHIEF OPERATING OFFICER)
(561) 513-8440
Entity
Organization
Contact information
Practice address
10385 IRONWOOD RD, SUITE 130, PALM BEACH GARDENS, FL 33410-4291
(561) 513-8440
(561) 370-6036
Mailing address
10385 IRONWOOD RD, SUITE 130, PALM BEACH GARDENS, FL 33410-4291
(561) 513-8440
(561) 370-6036
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015049900
—
FL
05
—
0155902
—
OH
05
—
100049019
—
WI
05
—
1025400
—
VT
05
—
1770980062
—
UT
01
—
34458
STATE LICENSE
PA
01
—
800027631
STATE LICENSE
FL
01
—
COS 00800603
STATE LICENSE
CA
01
—
IH908A
MEDICARE PTAN
—
01
—
P01611847
RR MEDICARE
—
Enumeration date
12/02/2014
Last updated
06/30/2016
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