MEDICARE: ROCKBRIDGE LABORATORY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1023283280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKBRIDGE LABORATORY, LLC

Provider Business Mailing Address
First Line	:	204 E WASHINGTON ST
Second Line	:	SUITE C
City	:	LEXINGTON
State	:	VA
Zip	:	24450-2718
Country	:	US
Telephone Number	:	540-761-1433
Fax Number	:	866-281-9602

Provider Business Practice Location Address
First Line	:	204 E WASHINGTON ST
Second Line	:	SUITE C
City	:	LEXINGTON
State	:	VA
Zip	:	24450-2718
Country	:	US
Telephone Number	:	540-761-1433
Fax Number	:	866-480-9460

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MS. ROBIN MARIE TAYLOR
Credential	:
Telephone Number	:	540-761-1433

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	09/17/2008

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