Provider Demographics
NPI:1619099363
Name:LAMAR REGIONAL HEALTH CENTER LAB
Entity Type:Organization
Organization Name:LAMAR REGIONAL HEALTH CENTER LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-698-7111
Mailing Address - Street 1:49494 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:SULLIGENT
Mailing Address - State:AL
Mailing Address - Zip Code:35586-4454
Mailing Address - Country:US
Mailing Address - Phone:205-698-7111
Mailing Address - Fax:205-698-0516
Practice Address - Street 1:49494 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:SULLIGENT
Practice Address - State:AL
Practice Address - Zip Code:35586-4454
Practice Address - Country:US
Practice Address - Phone:205-698-7111
Practice Address - Fax:205-698-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-24934OtherBCBS ALA. PROV #
AL051554629Medicaid
AL051554629Medicaid