Provider Demographics
NPI:1841061314
Name:PATRIOT DIAGNOSTICS LAB
Entity type:Organization
Organization Name:PATRIOT DIAGNOSTICS LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-659-2757
Mailing Address - Street 1:101 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:23075-1833
Mailing Address - Country:US
Mailing Address - Phone:804-659-2757
Mailing Address - Fax:804-773-4624
Practice Address - Street 1:101 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-1833
Practice Address - Country:US
Practice Address - Phone:804-659-2757
Practice Address - Fax:804-773-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center