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NPI Code Detail

MEDICARE: ORION BLOSSOM LLC

MEDICARE: ORION BLOSSOM LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory36D0953812OH

General Provider Information

NPI Number : 1962656900
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORION BLOSSOM LLC
Provider Business Mailing Address
First Line : 109 BLOSSOM LN
Second Line :
City : SALEM
State : OH
Zip : 44460-4284
Country : US
Telephone Number : 330-337-3033
Fax Number :
Provider Business Practice Location Address
First Line : 109 BLOSSOM LN
Second Line :
City : SALEM
State : OH
Zip : 44460-4284
Country : US
Telephone Number : 330-337-3033
Fax Number :
Authorized Official
Title or Position : CONTROLLER
Name : MR. DENNIS LOCKHART
Credential :
Telephone Number : 614-416-0600
Provider Enumeration Date : 11/04/2008
Last Update Date : 11/04/2008

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