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General NPI Number Information
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NPI Number | 1245498104
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Entity Type | Organization
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Legal Business Name | TAYLORVILLE MEDICAL ASSOCIATES LAB
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 303 E BIDWELL ST
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City | TAYLORVILLE
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State | IL
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Zip | 62568-1363
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Country | US
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Telephone | 217-824-4939
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Fax |
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Provider Business Mailing Address
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Address Line | 303 E BIDWELL ST
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City | TAYLORVILLE
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State | IL
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Zip | 62568-1363
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Country | US
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Telephone | 217-824-4939
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. RANDALL A BRYANT
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Credential |
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Telephone | 217-528-7541
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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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