Provider Demographics
NPI:1760650923
Name:PROHEALTH LABORATORY
Entity type:Organization
Organization Name:PROHEALTH LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF ANCILLARY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-284-5200
Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:950 YALE AVE
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1858
Practice Address - Country:US
Practice Address - Phone:203-269-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROHEALTH PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory