Provider Demographics
NPI:1629457338
Name:BLUFF CITY LABORATORY SERVICES
Entity Type:Organization
Organization Name:BLUFF CITY LABORATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAZEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:ZBYTEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD/PHD
Authorized Official - Phone:901-647-1302
Mailing Address - Street 1:8110 CORDOVA RD
Mailing Address - Street 2:SUITE 113A
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0520
Mailing Address - Country:US
Mailing Address - Phone:800-959-6105
Mailing Address - Fax:901-871-0981
Practice Address - Street 1:8110 CORDOVA RD
Practice Address - Street 2:SUITE 113A
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0520
Practice Address - Country:US
Practice Address - Phone:800-959-6105
Practice Address - Fax:901-871-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory