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General NPI Number Information
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NPI Number | 1154730463
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Entity Type | Organization
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Legal Business Name | RECOVERY LABORATORY, LLC
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 608 NORTH ST
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City | ADAIR
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State | IA
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Zip | 50002-1126
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Country | US
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Telephone | 515-298-7209
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Fax | 515-864-0408
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Provider Business Mailing Address
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Address Line | 5875 FLEUR DR
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City | DES MOINES
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State | IA
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Zip | 50321-2883
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Country | US
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Telephone | 515-298-7209
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Fax | 515-864-0408
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL J VASQUEZ
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Credential |
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Telephone | 515-865-5664
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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 | 16D2016890
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License Number State | IA
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