Provider Demographics
NPI:1053585893
Name:SHENANDOAH LABORATORIES, LLC
Entity type:Organization
Organization Name:SHENANDOAH LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TWYFORD-ZIEBKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-262-4757
Mailing Address - Street 1:158 CRIMSON CIR
Mailing Address - Street 2:RELIANCE ROAD SUITE
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-6611
Mailing Address - Country:US
Mailing Address - Phone:304-262-4757
Mailing Address - Fax:304-262-4759
Practice Address - Street 1:158 CRIMSON CIR
Practice Address - Street 2:RELIANCE ROAD SUITE
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-6611
Practice Address - Country:US
Practice Address - Phone:304-262-4757
Practice Address - Fax:304-262-4759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory