Healthcare Provider Details

I. General information

NPI: 1205896594
Provider Name (Legal Business Name): BOYCE - BYNUM PATHOLOGY LABORATORIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PORTLAND ST
COLUMBIA MO
65201
US

IV. Provider business mailing address

200 PORTLAND ST
COLUMBIA MO
65201-6525
US

V. Phone/Fax

Practice location:
  • Phone: 573-886-4600
  • Fax: 573-886-4695
Mailing address:
  • Phone: 573-886-4600
  • Fax: 573-886-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number26D0652373
License Number StateMO

VIII. Authorized Official

Name: RICHARD E COTTEN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 573-886-4600