Provider Demographics
NPI:1528281235
Name:ATHENS MEDICAL LABORATORY ASSOCIATES, INC.
Entity type:Organization
Organization Name:ATHENS MEDICAL LABORATORY ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-593-8240
Mailing Address - Street 1:400 EAST STATE STREET
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-593-8240
Mailing Address - Fax:740-592-5718
Practice Address - Street 1:400 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-593-8240
Practice Address - Fax:740-592-5718
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELTERING ARMS HOSPITAL FOUNDATION, INC DBA O'BLENESS MEMORIAL HOSP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-11
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D035113291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36D0351113OtherCLIA
OH0298682Medicaid
OHD368691Medicare PIN