Healthcare Provider Details

I. General information

NPI: 1558765552
Provider Name (Legal Business Name): REPRODUCTIVE LABORATORY OF TENNESSEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HUMPHREYS CENTER SUITE 307
MEMPHIS TN
38120-2363
US

IV. Provider business mailing address

80 HUMPHREYS CENTER SUITE 307
MEMPHIS TN
38120
US

V. Phone/Fax

Practice location:
  • Phone: 901-747-2229
  • Fax: 901-747-4446
Mailing address:
  • Phone: 901-747-2229
  • Fax: 901-747-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number0000003317
License Number StateTN

VIII. Authorized Official

Name: DR. WILLIAM H KUTTEH
Title or Position: LABORATORY DIRECTOR
Credential: MD, PHD, HCLD, CC
Phone: 901-747-2229