Healthcare Provider Details

I. General information

NPI: 1619099363
Provider Name (Legal Business Name): LAMAR REGIONAL HEALTH CENTER LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49494 HIGHWAY 17
SULLIGENT AL
35586-4454
US

IV. Provider business mailing address

49494 HIGHWAY 17
SULLIGENT AL
35586-4454
US

V. Phone/Fax

Practice location:
  • Phone: 205-698-7111
  • Fax: 205-698-0516
Mailing address:
  • Phone: 205-698-7111
  • Fax: 205-698-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier515-24934
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS ALA. PROV #
# 2
Identifier051554629
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer

VIII. Authorized Official

Name: MRS. SHERRY TAYLOR
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-698-7111