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General NPI Number Information
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NPI Number | 1952348757
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Entity Type | Organization
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Legal Business Name | RX INNOVATIONS, LLC, DBA FIRSTLAB OF VIRGINIA
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1701 WILL O WISP DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3102
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Country | US
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Telephone | 757-412-3273
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Fax | 757-412-6464
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Provider Business Mailing Address
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Address Line | 1701 WILL O WISP DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3102
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Country | US
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Telephone | 757-412-3273
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Fax | 757-412-6464
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MR. THOMAS ARNOLD FISCHER
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Credential | MS MT(ASCP)
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Telephone | 757-412-3273
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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 | 2005-108709-R
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License Number State | VA
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