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General NPI Number Information
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NPI Number | 1124646013
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Entity Type | Organization
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Legal Business Name | NAMIDA LAB INC.
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 1905 E MISSION BLVD STE 6
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3129
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Country | US
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Telephone | 479-334-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 E MISSION BLVD STE 6
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3129
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Country | US
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Telephone | 479-334-2834
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | DR. MIKE RUTHERFORD
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Credential | PH.D.
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Telephone | 479-334-2834
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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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