Provider Demographics
NPI:1063776052
Name:SLOCUM-RADSON MEDICAL LABORATORIES INC.
Entity type:Organization
Organization Name:SLOCUM-RADSON MEDICAL LABORATORIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IKECHUKWU
Authorized Official - Middle Name:H
Authorized Official - Last Name:OKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-544-7012
Mailing Address - Street 1:3700 HARDY ST STE 10
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3700 HARDY ST STE A2
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1553
Practice Address - Country:US
Practice Address - Phone:601-544-7012
Practice Address - Fax:601-544-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19875291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory