Provider Demographics
NPI:1881367589
Name:STORGE MEDICAL GROUP LLC
Entity type:Organization
Organization Name:STORGE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-457-4022
Mailing Address - Street 1:3506 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LISMAN
Mailing Address - State:AL
Mailing Address - Zip Code:36912-2843
Mailing Address - Country:US
Mailing Address - Phone:205-457-4022
Mailing Address - Fax:
Practice Address - Street 1:2000 CRAWFORD ST STE 1125
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9008
Practice Address - Country:US
Practice Address - Phone:205-457-4022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory