1134528052 NPI number — COMPLETE LAB & DRUG TEST

Table of content: WHITNEY DAWN ELMORE B.A (NPI 1639331010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134528052 NPI number — COMPLETE LAB & DRUG TEST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE LAB & DRUG TEST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134528052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 247824
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43224-7824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-596-7808
Provider Business Mailing Address Fax Number:
614-319-5050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4661 CLEVELAND AVE BLDG A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43231-5848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-269-7612
Provider Business Practice Location Address Fax Number:
614-319-5050
Provider Enumeration Date:
08/15/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HASSAN
Authorized Official First Name:
ISMAIL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO, CO-FOUNDER
Authorized Official Telephone Number:
614-269-7612

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)