Healthcare Provider Details

I. General information

NPI: 1396840187
Provider Name (Legal Business Name): CENTRAL LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 MAIN AVE
PINEVILLE WV
24874
US

IV. Provider business mailing address

PO BOX 1150
PINEVILLE WV
24874-1150
US

V. Phone/Fax

Practice location:
  • Phone: 304-732-9552
  • Fax: 304-732-9218
Mailing address:
  • Phone: 304-732-9552
  • Fax: 304-732-9218

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: SAMUEL A MUSCARI JR.
Title or Position: PRESIDENT
Credential: DO
Phone: 304-732-9552