Provider Demographics
NPI:1164651618
Name:WESTERN SLOPE LABORATORY LLC
Entity Type:Organization
Organization Name:WESTERN SLOPE LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-307-1168
Mailing Address - Street 1:1197 ROCHESTER RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6031
Mailing Address - Country:US
Mailing Address - Phone:248-307-1168
Mailing Address - Fax:248-307-1189
Practice Address - Street 1:1197 ROCHESTER RD
Practice Address - Street 2:SUITE K
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6031
Practice Address - Country:US
Practice Address - Phone:248-307-1168
Practice Address - Fax:248-307-1189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENTRY DIAGNOSTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-06
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D1047507291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory