Organization
ST. MARY'S MEDICAL MANAGEMENT HIGHLAWN LAB
Active
Parent organization
ST. MARY'S MEDICAL MANAGEMENT
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. MARY'S MEDICAL MANAGEMENT
Authorized official
DR. JAMES G. LIESEN DO (LABORATORY DIRECTOR)
(304) 399-7565
Entity
Organization
Contact information
Practice address
2828 1ST AVE, SUITE 305, HUNTINGTON, WV 25702-1236
(304) 399-7565
(304) 399-7568
Mailing address
PO BOX 88, WHITE SULPHUR SPRINGS, WV 24986-0088
(304) 536-5030
(304) 536-5031
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009673
—
WV
Enumeration date
10/30/2007
Last updated
05/08/2008
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