Basic Information
| Provider Information | |||||||||
| NPI: | 1861558041 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTERNAL MEDICINE LAB. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2527 | ||||||||
| Address2: | |||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368032527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347493385 | ||||||||
| FaxNumber: | 3347457672 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 N 20TH ST STE 6 | ||||||||
| Address2: | |||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347493385 | ||||||||
| FaxNumber: | 3347457672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | ROYAL | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | LAB DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3347493385 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INTERNAL MED ASSOCIATE P C | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | AL | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.