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General NPI Number Information
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NPI Number | 1962846790
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Entity Type | Organization
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Legal Business Name | INNOVATIVE DIAGNOSTIC LABORATORY
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 8751 PARK CENTRAL DR SUITE 200
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City | RICHMOND
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State | VA
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Zip | 23227-1157
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Country | US
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Telephone | 804-986-3660
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Fax |
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Provider Business Mailing Address
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Address Line | 8751 PARK CENTRAL DR SUITE 200
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City | RICHMOND
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State | VA
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Zip | 23227-1157
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Country | US
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Telephone | 804-986-3660
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL & CHIEF COMPLIANCE
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Name | JOANNA M HALSEY
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Credential |
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Telephone | 804-261-3341
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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 | VA
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