Organization
EXECUTOR DIAGNOSTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN G MCINVILLE JR. (BUSINESS SERVICE REPRESENTATIVE)
(843) 669-5162
Entity
Organization
Contact information
Practice address
1929 MOUNTAIN LAUREL CT # A, FLORENCE, SC 29505-6053
(843) 292-1112
Mailing address
1929A MOUNTAIN LAUREL CT, FLORENCE, SC 29505-6053
(843) 669-5162
(843) 667-4573
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
L00218
—
SC
Enumeration date
09/15/2006
Last updated
04/20/2008
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