Provider Demographics
NPI:1821471319
Name:MEDTEST LABORATORIES LLC
Entity Type:Organization
Organization Name:MEDTEST LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:405-285-0102
Mailing Address - Street 1:861 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5407
Mailing Address - Country:US
Mailing Address - Phone:405-285-0102
Mailing Address - Fax:405-509-2869
Practice Address - Street 1:3860 TEAYS VALLEY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9772
Practice Address - Country:US
Practice Address - Phone:304-757-9982
Practice Address - Fax:304-945-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV51D2098204291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory