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General NPI Number Information
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NPI Number | 1871593293
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Entity Type | Organization
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Legal Business Name | MOLECULAR PATHOLOGY SERVICES OF THE HENRY VOGT CANCER RESEARCH INST
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 529 S JACKSON ST STE 417
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City | LOUISVILLE
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State | KY
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Zip | 40202-3229
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Country | US
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Telephone | 502-852-7093
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Fax | 502-852-0886
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Provider Business Mailing Address
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Address Line | 529 S JACKSON ST STE 417
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City | LOUISVILLE
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State | KY
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Zip | 40202-3229
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Country | US
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Telephone | 502-852-7093
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Fax | 502-852-0886
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Authorized Official
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Title or Position | INTERIM DIRECTOR
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Name | DR. STEPHEN P SLONE
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Credential | MD
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Telephone | 502-852-0029
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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 | 200191
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License Number State | KY
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