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General NPI Number Information
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NPI Number | 1477332997
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Entity Type | Organization
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Legal Business Name | FIRST SOURCE TESTING LLC
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 3076 PALISADES CT STE D
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City | TUSCALOOSA
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State | AL
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Zip | 35405-3452
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Country | US
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Telephone | 205-886-8075
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Fax | 205-710-5595
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Provider Business Mailing Address
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Address Line | 3076 PALISADES CT STE D
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City | TUSCALOOSA
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State | AL
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Zip | 35405-3452
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Country | US
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Telephone | 205-886-8075
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Fax | 205-710-5595
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Authorized Official
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Title or Position | OWNER
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Name | MR. LARRY THOMAS JR.
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Credential |
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Telephone | 205-535-4020
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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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