Organization
M&T DIAGNOSTIC LAB SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELISSA K WILSON ASCP (OWNER)
(620) 515-0619
Entity
Organization
Contact information
Practice address
1411 W 4TH ST, COFFEYVILLE, KS 67337-3300
(620) 251-3666
Mailing address
1411 W 4TH ST, PO BOX 312, COFFEYVILLE, KS 67337-3300
(620) 251-3666
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00268596
RAILROAD MEDICARE
KS
Enumeration date
11/03/2005
Last updated
01/22/2008
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