Provider Demographics
NPI:1427370865
Name:COSHOCTON LABORATORY INTERNATIONAL LLC
Entity Type:Organization
Organization Name:COSHOCTON LABORATORY INTERNATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KELTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LMT
Authorized Official - Phone:740-622-3971
Mailing Address - Street 1:660 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1613
Mailing Address - Country:US
Mailing Address - Phone:740-622-3971
Mailing Address - Fax:740-622-3972
Practice Address - Street 1:660 MAIN ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1613
Practice Address - Country:US
Practice Address - Phone:740-622-3971
Practice Address - Fax:740-622-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D1100195291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory