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General NPI Number Information
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NPI Number | 1306508932
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Entity Type | Organization
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Legal Business Name | LOVING CARE SUPERIOR LAB
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 13427 WINDSONG DR
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City | GULFPORT
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State | MS
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Zip | 39503-5508
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Country | US
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Telephone | 228-547-9349
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Fax |
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Provider Business Mailing Address
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Address Line | 13427 WINDSONG DR
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City | GULFPORT
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State | MS
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Zip | 39503-5508
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Country | US
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Telephone | 228-547-9349
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAWANNA L BUMPERS
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Credential |
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Telephone | 228-547-9349
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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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