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General NPI Number Information
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NPI Number | 1427370865
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Entity Type | Organization
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Legal Business Name | COSHOCTON LABORATORY INTERNATIONAL LLC
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 660 MAIN ST
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City | COSHOCTON
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State | OH
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Zip | 43812-1613
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Country | US
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Telephone | 740-622-3971
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Fax | 740-622-3972
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Provider Business Mailing Address
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Address Line | 660 MAIN ST
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City | COSHOCTON
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State | OH
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Zip | 43812-1613
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Country | US
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Telephone | 740-622-3971
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Fax | 740-622-3972
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. TRACY LYNN KELTON
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Credential | RN, LMT
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Telephone | 740-622-3971
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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 | 36D1100195
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License Number State | OH
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