1528281235 NPI number — ATHENS MEDICAL LABORATORY ASSOCIATES, INC.

Table of content: (NPI 1528281235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528281235 NPI number — ATHENS MEDICAL LABORATORY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATHENS MEDICAL LABORATORY ASSOCIATES, INC.
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:
6
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:
1528281235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 EAST STATE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-593-8240
Provider Business Mailing Address Fax Number:
740-592-5718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 EAST STATE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-593-8240
Provider Business Practice Location Address Fax Number:
740-592-5718
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JENKINSON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
740-593-8240

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  36D035113 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36D0351113 . This is a "CLIA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0298682 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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