Provider Demographics
NPI:1285899567
Name:CRAIG COUNTY HEALTH CENTER - LAB
Entity type:Organization
Organization Name:CRAIG COUNTY HEALTH CENTER - LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-772-3064
Mailing Address - Street 1:226 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24127-6080
Mailing Address - Country:US
Mailing Address - Phone:540-864-6390
Mailing Address - Fax:540-864-6356
Practice Address - Street 1:226 MARKET ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:VA
Practice Address - Zip Code:24127-6080
Practice Address - Country:US
Practice Address - Phone:540-864-6390
Practice Address - Fax:540-864-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA49D1076445291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
491881Medicare Oscar/Certification