Healthcare Provider Details

I. General information

NPI: 1760574065
Provider Name (Legal Business Name): OSU HISTOLOGY LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 CHAMBERS RD
COLUMBUS OH
43212-1568
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-0345
  • Fax: 614-293-0324
Mailing address:
  • Phone: 614-293-0345
  • Fax: 614-293-0324

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: LESLIE STUMP
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential: MBA
Phone: 614-685-9763