Provider Demographics
NPI:1225523608
Name:RED MOUNTAIN DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:RED MOUNTAIN DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-313-4628
Mailing Address - Street 1:140 OXMOOR BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5985
Mailing Address - Country:US
Mailing Address - Phone:205-224-4490
Mailing Address - Fax:205-224-4524
Practice Address - Street 1:140 OXMOOR BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-224-4490
Practice Address - Fax:205-224-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207ZP0102X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty