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General NPI Number Information
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NPI Number | 1134528052
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Entity Type | Organization
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Legal Business Name | COMPLETE LAB & DRUG TEST
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 4661 CLEVELAND AVE BLDG A
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City | COLUMBUS
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State | OH
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Zip | 43231-5848
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Country | US
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Telephone | 614-269-7612
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Fax | 614-319-5050
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Provider Business Mailing Address
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Address Line | PO BOX 247824
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City | COLUMBUS
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State | OH
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Zip | 43224-7824
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Country | US
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Telephone | 614-596-7808
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Fax | 614-319-5050
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Authorized Official
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Title or Position | CEO, CO-FOUNDER
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Name | ISMAIL A HASSAN
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Credential | MLT(ASCP)
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Telephone | 614-269-7612
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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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