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General NPI Number Information
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NPI Number | 1568561512
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Entity Type | Organization
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Legal Business Name | PH ENTERPRISES INC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 200 E CENTENNIAL DR STE 10A
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City | PITTSBURG
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State | KS
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Zip | 66762-6571
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Country | US
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Telephone | 620-232-1900
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Fax | 620-232-8752
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Provider Business Mailing Address
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Address Line | 200 E CENTENNIAL DR STE 10A
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City | PITTSBURG
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State | KS
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Zip | 66762-6571
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Country | US
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Telephone | 620-232-1900
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Fax | 620-232-8752
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY D PETERSON
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Credential | MT ASCP
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Telephone | 620-232-1900
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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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