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General NPI Number Information
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NPI Number | 1306170329
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Entity Type | Organization
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Legal Business Name | MED QUIK LABS LLC
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 101 N RANGE LINE RD STE 322
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City | JOPLIN
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State | MO
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Zip | 64801-4118
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Country | US
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Telephone | 417-206-7845
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Fax | 417-782-6331
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Provider Business Mailing Address
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Address Line | PO BOX 3703
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City | JOPLIN
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State | MO
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Zip | 64803-3703
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Country | US
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Telephone | 417-206-7845
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Fax | 417-782-6331
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL GLENN PITTMAN
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Credential |
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Telephone | 417-850-1348
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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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