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General NPI Number Information
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NPI Number | 1821471319
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Entity Type | Organization
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Legal Business Name | MEDTEST LABORATORIES LLC
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 3860 TEAYS VALLEY RD SUITE 2
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City | HURRICANE
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State | WV
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Zip | 25526-9772
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Country | US
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Telephone | 304-757-9982
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Fax | 304-945-9093
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Provider Business Mailing Address
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Address Line | 861 E 33RD ST
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City | EDMOND
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State | OK
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Zip | 73013-5407
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Country | US
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Telephone | 405-285-0102
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Fax | 405-509-2869
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Authorized Official
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Title or Position | MEMBER
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Name | JAMES TAYLOR JR.
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Credential |
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Telephone | 405-285-0102
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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 | 51D2098204
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License Number State | WV
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