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General NPI Number Information
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NPI Number | 1205896594
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Entity Type | Organization
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Legal Business Name | BOYCE - BYNUM PATHOLOGY LABORATORIES, INC
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 200 PORTLAND ST
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City | COLUMBIA
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State | MO
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Zip | 65201
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Country | US
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Telephone | 573-886-4600
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Fax | 573-886-4695
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Provider Business Mailing Address
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Address Line | 200 PORTLAND ST
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City | COLUMBIA
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State | MO
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Zip | 65201-6525
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Country | US
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Telephone | 573-886-4600
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Fax | 573-886-4695
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | RICHARD E COTTEN
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Credential |
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Telephone | 573-886-4600
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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 | 26D0652373
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License Number State | MO
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