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General NPI Number Information
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NPI Number | 1174912695
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Entity Type | Organization
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Legal Business Name | MADISON CORE LABORATORIES, LLC
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 2705 ARTIE ST SW BLDG 400 SUITE 25
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City | HUNTSVILLE
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State | AL
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Zip | 35805
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Country | US
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Telephone | 256-850-0075
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Fax | 256-850-3186
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Provider Business Mailing Address
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Address Line | PO BOX 1565
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City | HUNTSVILLE
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State | AL
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Zip | 35807-0565
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Country | US
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Telephone | 256-850-0075
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Fax | 256-850-3186
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Authorized Official
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Title or Position | CREDENTIALING
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Name | GUY E JONES
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Credential |
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Telephone | 256-850-0075
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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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