Healthcare Provider Details

I. General information

NPI: 1790262962
Provider Name (Legal Business Name): SELECT LABORATORIES-MARION COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11115 SW 93RD COURT RD UNIT 100
OCALA FL
34481
US

IV. Provider business mailing address

1100 REVOLUTION MILL DR
GREENSBORO NC
27405-5067
US

V. Phone/Fax

Practice location:
  • Phone: 336-510-1120
  • Fax:
Mailing address:
  • Phone: 336-510-1120
  • 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: JAMES ANDREW MOORE
Title or Position: SENIOR ACCOUNTANT
Credential:
Phone: 336-510-1120