=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043296569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN MEDICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21647 RYAN RD
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48091-2795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-757-4200
-----------------------------------------------------
Fax | 586-757-8332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21647 RYAN RD
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48091-2795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-757-4200
-----------------------------------------------------
Fax | 586-757-8332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIA
-----------------------------------------------------
Name | DR. KENNETH MEYERS
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 586-757-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------