Basic Information
| Provider Information | |||||||||
| NPI: | 1467806646 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHG REFERENCE LAB, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5001 SPRING VALLEY RD | ||||||||
| Address2: | SUITE 600 EAST | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752443946 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1734 MADISON AVE | ||||||||
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| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381046414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143656100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2016 | ||||||||
| LastUpdateDate: | 06/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | WALSH | ||||||||
| AuthorizedOfficialFirstName: | DEREK | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2143656100 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VCPHCS, LP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | TN | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.