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General NPI Number Information
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NPI Number | 1225023005
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Entity Type | Organization
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Legal Business Name | BIOCELLUTIONS, INC
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 1775 MORIAH WOODS BLVD SUITE 8
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City | MEMPHIS
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State | TN
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Zip | 38117-7125
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Country | US
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Telephone | 901-273-0880
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Fax | 901-273-0884
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Provider Business Mailing Address
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Address Line | 1775 MORIAH WOODS BLVD SUITE 8
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City | MEMPHIS
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State | TN
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Zip | 38117-7125
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Country | US
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Telephone | 901-273-0880
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Fax | 901-273-0884
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Authorized Official
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Title or Position | DIRECTOR LABORATORY SERVICES
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Name | DR. BONNI J HAZELTON
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Credential | PHD
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Telephone | 901-273-0880
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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 | 0000002008
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License Number State | TN
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