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General NPI Number Information
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NPI Number | 1699287300
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Entity Type | Organization
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Legal Business Name | METRIC LAB SERVICES LLC
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 116 MARKETRIDGE DR
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City | RIDGELAND
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State | MS
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Zip | 39157-6009
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Country | US
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Telephone | 601-557-0204
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95546
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City | GRAPEVINE
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State | TX
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Zip | 76099-9703
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Country | US
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Telephone | 832-250-5335
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. SHERMAN KENNERSON
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Credential |
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Telephone | 972-679-0388
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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 | 25D2137603
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License Number State | MS
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