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General NPI Number Information
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NPI Number | 1114329109
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Entity Type | Organization
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Legal Business Name | INDEPENDENT LAB SERVICES
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 590 E WESTERN RESERVE RD BUILDING 5
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City | YOUNGSTOWN
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State | OH
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Zip | 44514-3354
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Country | US
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Telephone | 330-403-8034
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Fax | 330-629-2966
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Provider Business Mailing Address
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Address Line | 1027 BOARDMAN CANFIELD RD
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-4227
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Country | US
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Telephone | 330-629-2888
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Fax | 330-629-2946
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | NICOLE KENDRA-TOWNSEND
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Credential | CCS
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Telephone | 330-629-2888
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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 | 36D2068849
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License Number State | OH
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