Organization
WOODBURY CLINICAL LABORATORY, INC.
Active
Parent organization
AMERICAN ESOTERIC LABORATORIES
Organization subpart
Yes
Provider details
NPI number
Legal business name
AMERICAN ESOTERIC LABORATORIES
Authorized official
MRS. DELIA OLDHAM (DIRECTOR OF OPERATIONS)
(615) 443-7588
Entity
Organization
Contact information
Practice address
305 E HIGH ST, LEBANON, TN 37087-2901
(615) 443-7588
(615) 443-7458
Mailing address
PO BOX 2309, LEBANON, TN 37088-2309
(615) 443-7588
(615) 443-7458
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
0000002135
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000002135
STATE MEDICAL LABORATORY
TN
01
—
44D0659026
CLIA CERTIFICATE OF COMPL
TN
Enumeration date
04/19/2006
Last updated
08/18/2008
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