Provider Demographics
NPI:1841799764
Name:MOLECULAR DIAGNOSTICS LABORATORY
Entity type:Organization
Organization Name:MOLECULAR DIAGNOSTICS LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-224-4490
Mailing Address - Street 1:140 OXMOOR BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5985
Mailing Address - Country:US
Mailing Address - Phone:205-224-4490
Mailing Address - Fax:205-224-4524
Practice Address - Street 1:140 OXMOOR BLVD STE 140
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5985
Practice Address - Country:US
Practice Address - Phone:205-224-4490
Practice Address - Fax:205-224-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service