Healthcare Provider Details

I. General information

NPI: 1659431690
Provider Name (Legal Business Name): CPC REFERENCE LABS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W BANKHEAD ST
NEW ALBANY MS
38652-3314
US

IV. Provider business mailing address

PO BOX 2368
NEW ALBANY MS
38652-2475
US

V. Phone/Fax

Practice location:
  • Phone: 662-538-5794
  • Fax: 662-538-5796
Mailing address:
  • Phone: 662-538-5794
  • Fax: 662-538-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOSEPH R CAMPBELL
Title or Position: PRESIDENT CEO
Credential:
Phone: 662-538-5794