Healthcare Provider Details

I. General information

NPI: 1104216746
Provider Name (Legal Business Name): COSMAP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 COMMERCE ST SW STE H
CONOVER NC
28613-8245
US

IV. Provider business mailing address

PO BOX 939
CONOVER NC
28613-0939
US

V. Phone/Fax

Practice location:
  • Phone: 828-465-0066
  • Fax:
Mailing address:
  • Phone: 828-465-0066
  • 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: KRISTEN CARLTON
Title or Position: BILLING MANAGER
Credential:
Phone: 828-261-0467