MEDICARE: IG LABORATORY 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	44D2041004	TN

General Provider Information

NPI Number	:	1922350545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IG LABORATORY INC

Provider Business Mailing Address
First Line	:	2 INTERNATIONAL PLZ
Second Line	:	SUITE 510
City	:	NASHVILLE
State	:	TN
Zip	:	37217-2017
Country	:	US
Telephone Number	:	615-255-8880
Fax Number	:	615-255-1330

Provider Business Practice Location Address
First Line	:	2 INTERNATIONAL PLZ
Second Line	:	SUITE 510
City	:	NASHVILLE
State	:	TN
Zip	:	37217-2017
Country	:	US
Telephone Number	:	615-255-8880
Fax Number	:	615-255-1330

Authorized Official
Title or Position	:	CEO
Name	:	MR. ERIC DAHLHAUSER
Credential	:
Telephone Number	:	615-255-8880

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	10/05/2012

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Directions to “IG LABORATORY INC ” Practice Location

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