Provider Demographics
NPI:1528122678
Name:SELECT LABORATORIES SC LLC
Entity type:Organization
Organization Name:SELECT LABORATORIES SC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KNESEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-510-1120
Mailing Address - Street 1:1100 REVOLUTION MILL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5068
Mailing Address - Country:US
Mailing Address - Phone:336-510-1120
Mailing Address - Fax:336-235-3044
Practice Address - Street 1:1051 BILL BUYCK BLVD
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102
Practice Address - Country:US
Practice Address - Phone:336-235-2036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory