Provider Demographics
NPI:1538763636
Name:VISTALINK HEALTH LABORATORIES LLC
Entity type:Organization
Organization Name:VISTALINK HEALTH LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GAMBILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-306-0647
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24203-1907
Mailing Address - Country:US
Mailing Address - Phone:423-306-0647
Mailing Address - Fax:
Practice Address - Street 1:1275 OLD EUCLID CTR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3852
Practice Address - Country:US
Practice Address - Phone:423-306-0647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26D2240325OtherCLIA
VA49D2203565OtherCLIA