Organization
ADVANCED LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LOGAN MD (MEDICAL DIRECTOR)
(802) 775-7798
Entity
Organization
Contact information
Practice address
199 STRATTON RD, RUTLAND, VT 05701-4890
(802) 775-7798
(802) 775-7762
Mailing address
199 STRATTON RD, RUTLAND, VT 05701-4890
(802) 775-7798
(802) 775-7762
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
47D2042960
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47D2042960
CLIA
VT
Enumeration date
07/24/2012
Last updated
07/24/2012
Update your record
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