Provider Demographics
NPI:1255495065
Name:B. R. DEVABHAKTHUNI & S. P.MULPURU PTR
Entity Type:Organization
Organization Name:B. R. DEVABHAKTHUNI & S. P.MULPURU PTR
Other - Org Name:PEDIATRIC PARTNERS LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-366-2818
Mailing Address - Street 1:312 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3611
Mailing Address - Country:US
Mailing Address - Phone:304-366-2818
Mailing Address - Fax:304-366-7614
Practice Address - Street 1:312 10TH ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3611
Practice Address - Country:US
Practice Address - Phone:304-366-2818
Practice Address - Fax:304-366-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory