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General NPI Number Information
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NPI Number | 1437533254
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Entity Type | Organization
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Legal Business Name | OTTENDORF LABORATORIES, LLC
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 1095 INVESTMENT BLVD
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City | APEX
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State | NC
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Zip | 27502-1799
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Country | US
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Telephone | 919-390-3566
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Fax | 919-629-8402
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Provider Business Mailing Address
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Address Line | 3922 GISBOURNE DR
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City | JAMESTOWN
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State | NC
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Zip | 27282-7706
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Country | US
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Telephone | 302-518-3022
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER AND MANAGER
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Name | KONRAD H KAEDING
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Credential |
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Telephone | 302-593-5904
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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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