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General NPI Number Information
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NPI Number | 1649332925
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Entity Type | Organization
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Legal Business Name | PIKEVILLE MEDICAL BUILDING LAB., INC.
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 387 TOWN MOUNTAIN RD SUITE 203
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City | PIKEVILLE
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State | KY
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Zip | 41501-1640
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Country | US
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Telephone | 606-432-1266
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Fax | 606-432-1944
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Provider Business Mailing Address
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Address Line | PO BOX 2529
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City | PIKEVILLE
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State | KY
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Zip | 41502-2529
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Country | US
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Telephone | 606-432-1266
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Fax | 606-432-1944
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Authorized Official
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Title or Position | OWNER-OPERATOR
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Name | MRS. ELLEN K HALL
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Credential | BSMT(ASCP)
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Telephone | 606-432-1266
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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 | 200148
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License Number State | KY
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