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General NPI Number Information
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NPI Number | 1629738091
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Entity Type | Organization
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Legal Business Name | PHA LAB SERVICES
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 4770 INDIANOLA AVE STE 101B
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City | COLUMBUS
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State | OH
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Zip | 43214-1876
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Country | US
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Telephone | 614-601-6434
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Fax |
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Provider Business Mailing Address
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Address Line | 4770 INDIANOLA AVE STE 101B
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City | COLUMBUS
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State | OH
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Zip | 43214-1876
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Country | US
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Telephone | 614-601-6434
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Fax |
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Authorized Official
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Title or Position | PART OWNER
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Name | KARA CLARK
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Credential |
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Telephone | 614-601-6434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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