Organization
COLBERT LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY L BRILES MLT (ADMINISTRATOR)
(256) 332-6602
Entity
Organization
Contact information
Practice address
128 GUARD ST, RUSSELLVILLE, AL 35653
(256) 332-6602
(256) 332-6690
Mailing address
PO BOX 547, RUSSELLVILLE, AL 35653-0547
(256) 332-6602
(256) 332-6690
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
09778
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57244
BLUE CROSS
AL
Enumeration date
09/01/2005
Last updated
08/01/2007
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