Healthcare Provider Details

I. General information

NPI: 1558598011
Provider Name (Legal Business Name): WEST VIRGINIA LABORATORY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 DUNBAR AVE
DUNBAR WV
25064-2920
US

IV. Provider business mailing address

1301 DUNBAR AVE
DUNBAR WV
25064-2920
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-9791
  • Fax: 304-720-9794
Mailing address:
  • Phone: 304-720-9791
  • Fax: 304-720-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number2227-2799
License Number StateWV

VIII. Authorized Official

Name: DR. DAVID J PATTON
Title or Position: DIRECTOR
Credential: MD
Phone: 304-345-4525