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General NPI Number Information
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NPI Number | 1568612307
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Entity Type | Organization
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Legal Business Name | ROOSTER ONE
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 1740 WOODRUFF RD
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City | GREENVILLE
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State | SC
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Zip | 29607-5933
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Country | US
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Telephone | 864-676-9830
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 WOODRUFF RD
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City | GREENVILLE
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State | SC
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Zip | 29607-5933
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Country | US
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Telephone | 864-676-9830
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Fax |
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Authorized Official
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Title or Position | RT
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Name | MS. SUSAN F WORKMAN
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Credential |
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Telephone | 864-676-9830
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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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