MEDICARE: CRAIG COUNTY HEALTH CENTER - LAB

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	49D1076445	VA

General Provider Information

NPI Number	:	1285899567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG COUNTY HEALTH CENTER - LAB

Provider Business Mailing Address
First Line	:	226 MARKET ST
Second Line	:
City	:	NEW CASTLE
State	:	VA
Zip	:	24127-6080
Country	:	US
Telephone Number	:	540-864-6390
Fax Number	:	540-864-6356

Provider Business Practice Location Address
First Line	:	226 MARKET ST
Second Line	:
City	:	NEW CASTLE
State	:	VA
Zip	:	24127-6080
Country	:	US
Telephone Number	:	540-864-6390
Fax Number	:	540-864-6356

Authorized Official
Title or Position	:	COO
Name	:	MICHELLE BALLARD
Credential	:
Telephone Number	:	304-772-3064

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	01/23/2012

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