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General NPI Number Information
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NPI Number | 1407893993
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Entity Type | Organization
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Legal Business Name | PATHOLOGISTS REGIONAL LABORATORY
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 415 6TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2431
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Country | US
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Telephone | 208-746-0516
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Fax | 208-746-4989
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Provider Business Mailing Address
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Address Line | 415 6TH STREET
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City | LEWISTON
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State | ID
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Zip | 83501
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Country | US
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Telephone | 208-746-0516
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Fax | 208-746-4989
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Authorized Official
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Title or Position | ADMINISTATIVE SUPERVISOR
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Name | LOU ANN LAZZARINI
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Credential |
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Telephone | 208-798-3635
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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 | I033
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License Number State | ID
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