Provider Demographics
NPI:1730105719
Name:REGIONAL MEDICAL LABORATORIES, INC.
Entity Type:Organization
Organization Name:REGIONAL MEDICAL LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEPOMPOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-969-6161
Mailing Address - Street 1:175 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-3432
Mailing Address - Country:US
Mailing Address - Phone:269-969-6161
Mailing Address - Fax:269-969-6078
Practice Address - Street 1:175 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3432
Practice Address - Country:US
Practice Address - Phone:269-969-6161
Practice Address - Fax:269-969-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D30377486291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1839676Medicaid
MI690A315040OtherBCBSM
MI690A315040OtherBCBSM