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General NPI Number Information
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NPI Number | 1417948969
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Entity Type | Organization
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Legal Business Name | M&T DIAGNOSTIC LAB SERVICES
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 1411 W 4TH ST
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City | COFFEYVILLE
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State | KS
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Zip | 67337-3300
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Country | US
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Telephone | 620-251-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 W 4TH ST PO BOX 312
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City | COFFEYVILLE
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State | KS
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Zip | 67337-3300
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Country | US
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Telephone | 620-251-3666
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MELISSA K WILSON
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Credential | ASCP
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Telephone | 620-515-0619
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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 | KS
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