Provider Demographics
NPI:1629520853
Name:MOUNTAINEER LABORATORIES LLC
Entity Type:Organization
Organization Name:MOUNTAINEER LABORATORIES LLC
Other - Org Name:MOUNTAINEER TOXICOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-593-1369
Mailing Address - Street 1:3 PEBBLE LANE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-0470
Mailing Address - Country:US
Mailing Address - Phone:304-593-1369
Mailing Address - Fax:
Practice Address - Street 1:1410 JEFFERSON BLVD # B
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1344
Practice Address - Country:US
Practice Address - Phone:304-593-1369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory