MEDICARE: LABTECH, INC

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		MS

General Provider Information

NPI Number	:	1568858546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABTECH, INC

Provider Business Mailing Address
First Line	:	127 PRATT DR
Second Line	:
City	:	CORINTH
State	:	MS
Zip	:	38834-6026
Country	:	US
Telephone Number	:	877-999-7525
Fax Number	:	877-999-7541

Provider Business Practice Location Address
First Line	:	127 PRATT DR
Second Line	:
City	:	CORINTH
State	:	MS
Zip	:	38834-6026
Country	:	US
Telephone Number	:	877-999-7525
Fax Number	:	877-999-7541

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DONALD O KING III
Credential	:
Telephone Number	:	662-293-0220

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	04/07/2015

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Directions to “LABTECH, INC ” Practice Location

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