Provider Demographics
NPI:1558765552
Name:REPRODUCTIVE LABORATORY OF TENNESSEE, INC.
Entity Type:Organization
Organization Name:REPRODUCTIVE LABORATORY OF TENNESSEE, INC.
Other - Org Name:REPRODUCTIVE LABORATORY, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:KUTTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD, HCLD, CC
Authorized Official - Phone:901-747-2229
Mailing Address - Street 1:80 HUMPHREYS CENTER
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-747-2229
Mailing Address - Fax:901-747-4446
Practice Address - Street 1:80 HUMPHREYS CENTER
Practice Address - Street 2:SUITE 307
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2363
Practice Address - Country:US
Practice Address - Phone:901-747-2229
Practice Address - Fax:901-747-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003317291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory