Organization
FERNANDO HERNANDEZ
Active
Other names
121 century medical lab
Organization subpart
No
Provider details
NPI number
Authorized official
FERNANDO HERNANDEZ (PRESIDENT)
18773076654
Entity
Organization
Contact information
Practice address
713 W 27TH ST, SCOTTSBLUFF, NE 69361-4412
(187) 730-7665
Mailing address
713 W 27TH ST, SCOTTSBLUFF, NE 69361-4412
(187) 730-7665
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
NE
Other
Enumeration date
03/02/2007
Last updated
08/22/2020
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