Provider Demographics
NPI:1013673243
Name:MOLECULAR AND DIAGNOSTIC TESTING LABS OF AMERICA
Entity Type:Organization
Organization Name:MOLECULAR AND DIAGNOSTIC TESTING LABS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-412-8934
Mailing Address - Street 1:1529 CLIFF GOOKIN BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6401
Mailing Address - Country:US
Mailing Address - Phone:901-412-8934
Mailing Address - Fax:
Practice Address - Street 1:729 3RD AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-2017
Practice Address - Country:US
Practice Address - Phone:901-412-8934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOLECULAR AND DIAGNOSTIC TESTING LABS OF AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory