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General NPI Number Information
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NPI Number | 1992789507
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Entity Type | Organization
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Legal Business Name | FERGUSON MEDICAL LABORATORIES INC
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 1801 W 32ND ST BLDG B SUITE 101
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City | JOPLIN
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State | MO
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Zip | 64804-1528
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Country | US
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Telephone | 417-623-6330
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Fax | 417-623-3950
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Provider Business Mailing Address
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Address Line | PO BOX 20452 FML-CREDENTIALING
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City | COLUMBUS
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State | OH
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Zip | 43220-0452
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Country | US
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Telephone | 614-442-2406
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Fax | 614-442-2410
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL P HURLY
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Credential | M.D.
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Telephone | 417-623-6330
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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 | 26D0666300
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 26D0445616
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 26D0445668
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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