Provider Demographics
NPI:1336424555
Name:HUNTSVILLE CLINIC LAB LLC
Entity Type:Organization
Organization Name:HUNTSVILLE CLINIC LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBIN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-535-5944
Mailing Address - Street 1:420 LOWELL DR SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3754
Mailing Address - Country:US
Mailing Address - Phone:256-535-5944
Mailing Address - Fax:888-389-4041
Practice Address - Street 1:420 LOWELL DR SE
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3754
Practice Address - Country:US
Practice Address - Phone:256-535-5944
Practice Address - Fax:888-389-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory