Provider Demographics
NPI:1689499295
Name:MIRACLE MEDICAL TESTING
Entity type:Organization
Organization Name:MIRACLE MEDICAL TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-377-5484
Mailing Address - Street 1:2564 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4100
Mailing Address - Country:US
Mailing Address - Phone:609-246-3956
Mailing Address - Fax:
Practice Address - Street 1:2564 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4100
Practice Address - Country:US
Practice Address - Phone:609-246-3956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty