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General NPI Number Information
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NPI Number | 1629457338
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Entity Type | Organization
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Legal Business Name | BLUFF CITY LABORATORY SERVICES
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 8110 CORDOVA RD SUITE 113A
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City | CORDOVA
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State | TN
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Zip | 38016-0520
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Country | US
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Telephone | 800-959-6105
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Fax | 901-871-0981
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Provider Business Mailing Address
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Address Line | 8110 CORDOVA RD SUITE 113A
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City | CORDOVA
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State | TN
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Zip | 38016-0520
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Country | US
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Telephone | 800-959-6105
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Fax | 901-871-0981
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BLAZEJ ZBYTEK
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Credential | MD/PHD
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Telephone | 901-647-1302
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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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