Organization
PHILLIP J STATES LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP J STATES MD (OWNER)
(814) 938-3550
Entity
Organization
Contact information
Practice address
1464 N MAIN ST STE 5, PUNXSUTAWNEY, PA 15767-2609
(814) 938-3550
(814) 938-3679
Mailing address
1464 N MAIN ST STE 5, PUNXSUTAWNEY, PA 15767-2609
(814) 938-3550
(814) 938-3679
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
MD423371
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019257860001
—
PA
Enumeration date
07/25/2007
Last updated
07/25/2007
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