Organization
BOSTWICK LABORATORIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID GRANGER BOSTWICK MD (CEO, PRESIDENT, CHIEF MED. OFFICER)
(804) 967-9225
Entity
Organization
Contact information
Practice address
4851 LAKE BROOK DR, GLEN ALLEN, VA 23060-9233
(804) 967-9225
(804) 239-1954
Mailing address
PO BOX 403751, ATLANTA, GA 30384-3751
(804) 967-9225
(804) 239-1954
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000265139
UNISON HEALTH (OH MEDICAID HMO)
OH
05
—
010062811
—
VA
05
—
01837399
—
MS
01
—
036874800
DC MEDICAID (ACS)
DC
05
—
036874800
—
DC
05
—
0421311
—
MT
05
—
0578229
—
IA
05
—
100503849
—
NV
05
—
1009021320002
—
PA
05
—
1198722
—
LA
05
—
120124700
—
WY
01
—
138056
ANTHEM BCBS OF VIRGINIA
VA
05
—
152979709
—
AR
05
—
164040101
—
TX
05
—
164650710
—
MI
05
—
1900009
—
RI
01
—
190000932
MEDICARE PTAN
VA
05
—
1952465288
—
MN
05
—
200024720A
—
OK
05
—
200262210A
—
KS
05
—
200375010A
—
IN
01
—
20073351
SC SELECT HEALTH /MEDICAID HMO
SC
05
—
2420571
—
OH
05
—
275326 MCD
—
OR
05
—
32287232
—
CO
05
—
32940800
—
WI
05
—
37000718
—
KY
05
—
409261900
—
MD
05
—
419300000
—
ME
05
—
440615
—
AZ
05
—
4582490
—
TN
01
—
533631
MERCY CARE PLAN
AZ
05
—
568644630A
—
GA
05
—
6701112000
—
WV
05
—
690000006
—
AL
05
—
7001242
—
NC
05
—
706132305
—
MO
05
—
7123995
—
WA
05
—
8069026
—
ID
05
—
82083339
—
NM
05
—
911980900
—
FL
05
—
L00184
—
SC
Enumeration date
12/21/2006
Last updated
05/22/2012
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