Provider Demographics
NPI:1497920730
Name:BRISTOL LABORATORIES, LLC
Entity Type:Organization
Organization Name:BRISTOL LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:KRISTIN
Authorized Official - Last Name:PALIN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:423-652-2368
Mailing Address - Street 1:337 BLUFF CITY HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-4629
Mailing Address - Country:US
Mailing Address - Phone:423-652-2368
Mailing Address - Fax:
Practice Address - Street 1:337 BLUFF CITY HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4629
Practice Address - Country:US
Practice Address - Phone:423-652-2368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory