Organization
PH ENTERPRISES INC
Active
Other names
Mag Lab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY D PETERSON MT ASCP (OWNER)
(620) 232-1900
Entity
Organization
Contact information
Practice address
200 E CENTENNIAL DR, STE 10A, PITTSBURG, KS 66762-6571
(620) 232-1900
(620) 232-8752
Mailing address
200 E CENTENNIAL DR, STE 10A, PITTSBURG, KS 66762-6571
(620) 232-1900
(620) 232-8752
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100374300A
—
KS
01
—
690009001
RR MEDICARE
KS
Enumeration date
09/22/2006
Last updated
08/11/2015
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