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General NPI Number Information
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NPI Number | 1609963834
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Entity Type | Organization
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Legal Business Name | VALLEY DIAGNOSTIC LABORATORIES INC
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 1504 JACKSON PIKE
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1387
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Country | US
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Telephone | 740-446-0353
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Fax | 740-441-0733
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Provider Business Mailing Address
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Address Line | 1504 JACKSON PIKE P.O.BOX 33
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1387
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Country | US
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Telephone | 740-446-0353
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Fax | 740-441-0733
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. KIMBERLY G GOLDCAMP
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Credential | MT(ASCP)
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Telephone | 740-446-0353
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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 | 570251
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License Number State | OH
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