Provider Demographics
NPI:1053119362
Name:EASTERN PANHANDLE LAB
Entity type:Organization
Organization Name:EASTERN PANHANDLE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O2
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:ERB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-203-9332
Mailing Address - Street 1:275 SMOKEY LN
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-5061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 SMOKEY LN
Practice Address - Street 2:
Practice Address - City:HEDGESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25427-5061
Practice Address - Country:US
Practice Address - Phone:703-203-9332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty