Organization
ARCHER CLINIC LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NOEL MARIE GILLIAM (LABORATORY MANAGER)
(606) 886-6302
Entity
Organization
Contact information
Practice address
400 UNIVERSITY DR, SUITE 105, PRESTONSBURG, KY 41653-1080
(606) 886-6302
(606) 886-0597
Mailing address
400 UNIVERSITY DR, SUITE 105, PRESTONSBURG, KY 41653-1080
(606) 886-6302
(606) 886-0597
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
200111
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37901055
—
KY
Enumeration date
08/04/2005
Last updated
12/31/2007
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