Provider Demographics
NPI:1912291774
Name:CONCENTRA LABORATORY LLC
Entity Type:Organization
Organization Name:CONCENTRA LABORATORY LLC
Other - Org Name:ADVANCED TOXICOLOGY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUSSATTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-370-5184
Mailing Address - Street 1:5080 SPECTRUM DRIVE
Mailing Address - Street 2:SUITE 1200 WEST TOWER
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3560 AIR CENTER CV
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3626
Practice Address - Country:US
Practice Address - Phone:901-794-5770
Practice Address - Fax:901-794-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory