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General NPI Number Information
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NPI Number | 1134273808
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Entity Type | Organization
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Legal Business Name | KING JAMES MEDICAL LABORATORY INC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 24700 CENTER RIDGE RD SUITE 113
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City | WESTLAKE
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State | OH
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Zip | 44145-5636
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Country | US
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Telephone | 440-835-2150
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Fax |
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Provider Business Mailing Address
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Address Line | 24700 CENTER RIDGE RD SUITE 113
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City | WESTLAKE
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State | OH
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Zip | 44145-5636
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Country | US
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Telephone | 440-835-2150
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MRS. SUSAN ANN WENGER
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Credential |
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Telephone | 440-835-2150
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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 | 36D0339322
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License Number State | OH
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