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General NPI Number Information
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NPI Number | 1053850206
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Entity Type | Organization
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Legal Business Name | BLUEWEST/LAB LLC
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 1076 STAMPER RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4191
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Country | US
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Telephone | 336-255-8285
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Fax |
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Provider Business Mailing Address
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Address Line | 1076 STAMPER RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4191
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Country | US
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Telephone | 336-255-8285
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. RACHELLE BROOKS-BLUE
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Credential |
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Telephone | 910-257-4339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 34D2122291
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License Number State | NC
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