Provider Demographics
NPI:1063449320
Name:TRUMBULL LABORATORIES, LLC
Entity Type:Organization
Organization Name:TRUMBULL LABORATORIES, LLC
Other - Org Name:TRUMBULL LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-542-6801
Mailing Address - Street 1:7550 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1745
Mailing Address - Country:US
Mailing Address - Phone:901-542-6801
Mailing Address - Fax:901-542-6871
Practice Address - Street 1:7550 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1745
Practice Address - Country:US
Practice Address - Phone:901-542-6801
Practice Address - Fax:901-542-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003329291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4085060OtherBLUE CARE
MO703898908OtherMEDICAID
TN4085060OtherBLUE CROSS BLUE SHIELD
TN000000009507OtherMEMPHIS MANAGED CARE
AR136329709OtherMEDICAID
TN3403400Medicaid
690008145OtherRAIL ROAD MEDICARE
MS0120065OtherMEDICAID
TN3403400Medicare ID - Type Unspecified