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General NPI Number Information
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NPI Number | 1558791517
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Entity Type | Organization
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Legal Business Name | GNOME DIAGNOSTICS LLC
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 1476 MANNING PKWY SUITE G
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City | POWELL
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State | OH
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Zip | 43065-7295
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Country | US
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Telephone | 614-431-6414
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Fax | 877-591-1815
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Provider Business Mailing Address
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Address Line | 1476 MANNING PKWY SUITE G
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City | POWELL
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State | OH
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Zip | 43065-7295
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Country | US
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Telephone | 614-431-6414
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Fax | 877-591-1815
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Authorized Official
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Title or Position | MANAGER
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Name | ADEL MIKHAIL
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Credential |
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Telephone | 614-431-6414
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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 | 36D2068194
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License Number State | OH
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