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General NPI Number Information
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NPI Number | 1235290651
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Entity Type | Organization
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Legal Business Name | NC DEPT OF HEALTH AND HUMAN SERVICE
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 4312 DISTRICT DR
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City | RALEIGH
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State | NC
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Zip | 27607-5490
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Country | US
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Telephone | 919-733-7834
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Fax | 919-733-8695
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Provider Business Mailing Address
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Address Line | MSC 1918
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City | RALEIGH
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State | NC
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Zip | 27699-1918
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Country | US
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Telephone | 919-733-7834
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Fax | 919-733-8695
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. SCOTT MICHAEL SHONE
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Credential | PHD, HCLD(ABB)
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Telephone | 919-807-8990
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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 | 34D0692393
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License Number State | NC
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