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General NPI Number Information
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NPI Number | 1952880577
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Entity Type | Organization
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Legal Business Name | PROMEDICA PATHOLOGY LABORATORIES LLC
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 2130 W CENTRAL AVE STE 300
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City | TOLEDO
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State | OH
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Zip | 43606-3819
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Country | US
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Telephone | 419-291-4134
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Fax | 419-534-2562
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Provider Business Mailing Address
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Address Line | 12357 RIATA TRACE PKWY STE A210
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City | AUSTIN
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State | TX
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Zip | 78727-7168
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Country | US
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Telephone | 512-439-1600
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Fax | 512-795-5069
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES A MUSIAL
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Credential |
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Telephone | 512-439-1600
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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 |
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License Number State |
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