Provider Demographics
NPI:1346892650
Name:WEST VIRGINIA LABORATORIES
Entity Type:Organization
Organization Name:WEST VIRGINIA LABORATORIES
Other - Org Name:WV LABS
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHERY
Authorized Official - Middle Name:EZRA
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-400-6028
Mailing Address - Street 1:PO BOX 4816
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25364-4816
Mailing Address - Country:US
Mailing Address - Phone:304-400-6028
Mailing Address - Fax:
Practice Address - Street 1:1740 UNION CARBIDE DR BLDG 740
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-2732
Practice Address - Country:US
Practice Address - Phone:304-400-6028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory