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Organization

SOUTHERN MEDICAL LABORATORIES INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. PAMELA JILL GERALDS BILLING SUPERVISOR (SUPERVISOR)
(270) 651-2989
Entity
Organization

Contact information

Practice address
1407 N RACE ST STE 3, GLASGOW, KY 42141-3474
(270) 651-2989
(270) 651-7690
Mailing address
1407 N RACE ST STE 3, GLASGOW, KY 42141-3474
(270) 651-2989
(270) 651-7690

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
200129
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000061985
ANTHEM KENTUCKY BCBS
01
18D0325975
CLIA CERTIFICATE NUMBER
05
37901246
KY
Enumeration date
07/28/2006
Last updated
08/02/2011
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