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General NPI Number Information
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NPI Number | 1093912297
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Entity Type | Organization
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Legal Business Name | SHASTA MEDICAL LAB
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 1555 EAST ST SUITE 300
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City | REDDING
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State | CA
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Zip | 96001-1153
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Country | US
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Telephone | 530-242-4694
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 EAST ST SUITE 300
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City | REDDING
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State | CA
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Zip | 96001-1153
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Country | US
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Telephone | 530-242-4694
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Fax |
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Authorized Official
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Title or Position | BILLING
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Name | SHAWNA L SMITH
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Credential |
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Telephone | 530-244-6716
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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 |
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License Number State |
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