Provider Demographics
NPI:1063725992
Name:STEWARD MEDICAL LABORATORIES LLC
Entity type:Organization
Organization Name:STEWARD MEDICAL LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-789-2706
Mailing Address - Street 1:909 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3396
Mailing Address - Country:US
Mailing Address - Phone:508-427-2356
Mailing Address - Fax:617-562-7241
Practice Address - Street 1:909 SUMNER ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3396
Practice Address - Country:US
Practice Address - Phone:508-427-2356
Practice Address - Fax:617-562-7241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEWARD HEALTH CARE SYSTEM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory