Provider Demographics
NPI:1336530013
Name:MEDICAL ARTS LABORATORY, INC
Entity Type:Organization
Organization Name:MEDICAL ARTS LABORATORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:NARAMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-686-0308
Mailing Address - Street 1:407 S MEDICAL ARTS CT STE E
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3372
Mailing Address - Country:US
Mailing Address - Phone:307-682-1234
Mailing Address - Fax:307-686-6167
Practice Address - Street 1:407 S MEDICAL ARTS CT STE E
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3372
Practice Address - Country:US
Practice Address - Phone:307-682-1234
Practice Address - Fax:307-686-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY139514900Medicaid
WYW26866Medicare PIN