Healthcare Provider Details

I. General information

NPI: 1154718930
Provider Name (Legal Business Name): BG LABORATORY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W DIVISION ST
DOVER DE
19904-2702
US

IV. Provider business mailing address

600 W DIVISION ST
DOVER DE
19904-2702
US

V. Phone/Fax

Practice location:
  • Phone: 888-398-8841
  • Fax:
Mailing address:
  • Phone: 888-398-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KIMBERLY MILLIGAN
Title or Position: CEO/LABORATORY DIRECTOR
Credential: PHD
Phone: 888-398-8841