Healthcare Provider Details

I. General information

NPI: 1225870454
Provider Name (Legal Business Name): GRMC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N 4TH ST
OAKLAND MD
21550-1375
US

IV. Provider business mailing address

PO BOX 1617
MORGANTOWN WV
26507-1617
US

V. Phone/Fax

Practice location:
  • Phone: 301-533-4000
  • Fax:
Mailing address:
  • Phone:
  • 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: MARK G BOUCOT
Title or Position: PRESIDENT
Credential:
Phone: 301-533-4000