Provider Demographics
NPI:1144429929
Name:CONCENTRA LABORATORY LLC
Entity Type:Organization
Organization Name:CONCENTRA LABORATORY LLC
Other - Org Name:ADVANCED TOXICOLOGY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:CHAPMAN
Authorized Official - Last Name:BOGEMA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-794-5770
Mailing Address - Street 1:3560 AIR CENTER CV
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3626
Mailing Address - Country:US
Mailing Address - Phone:901-794-5770
Mailing Address - Fax:901-794-6460
Practice Address - Street 1:3560 AIR CENTER CV
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3626
Practice Address - Country:US
Practice Address - Phone:901-794-5770
Practice Address - Fax:901-794-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory