Organization
RENALAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL THOMAS BURNEY (COO)
(615) 370-6740
Entity
Organization
Contact information
Practice address
197 INTERSTATE DRIVE, SUITE G, RICHLAND, MS 39218
(615) 370-6760
(615) 370-6766
Mailing address
PO BOX 403096, ATLANTA, GA 30384-3096
(615) 370-6760
(615) 370-6766
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
25D0883339
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118180
—
MS
Enumeration date
08/03/2006
Last updated
04/24/2008
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