Organization
MOSAIC PRIME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIA DAHL M.D. (CHIEF MEDICAL OFFICER)
(901) 568-6009
Entity
Organization
Contact information
Practice address
20 DUDLEY ST, SUITE 250, MEMPHIS, TN 38103-4904
(901) 866-1655
(866) 359-8798
Mailing address
1318 MARSH CREEK LN, COLLIERVILLE, TN 38017-3940
(901) 568-6009
(866) 359-8798
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
44D1053242
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44D1053242
CLIA CERTIFICATION LAB
TN
Enumeration date
05/22/2007
Last updated
11/17/2015
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