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General NPI Number Information
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NPI Number | 1699789685
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Entity Type | Organization
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Legal Business Name | SOUTHERN MEDICAL LABORATORIES INC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 1407 N RACE ST STE 3
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City | GLASGOW
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State | KY
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Zip | 42141-3474
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Country | US
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Telephone | 270-651-2989
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Fax | 270-651-7690
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Provider Business Mailing Address
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Address Line | 1407 N RACE ST STE 3
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City | GLASGOW
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State | KY
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Zip | 42141-3474
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Country | US
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Telephone | 270-651-2989
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Fax | 270-651-7690
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MRS. PAMELA JILL GERALDS
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Credential | BILLING SUPERVISOR
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Telephone | 270-651-2989
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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 | 200129
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License Number State | KY
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