Forum Health Outreach Laboratories, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

FORUM HEALTH OUTREACH LABORATORIES, INC.

Practice address

811 Southwestern Run
Youngstown, OH 44514-3688

Phone

(330) 629-8033

Fax

(330) 629-9952

NPI assigned

Sep 28, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael G Seelman

Title

Chief Operating Officer

Phone

(330) 841-3540

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Clin Lab Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200355200000",
    "number": "1467449124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 SOUTHWESTERN RUN",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445143688",
            "telephone_number": "330-629-8033",
            "fax_number": "330-629-9952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 SOUTHWESTERN RUN",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445143688",
            "telephone_number": "330-629-8033",
            "fax_number": "330-629-9952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORUM HEALTH OUTREACH LABORATORIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-28",
        "last_updated": "2008-01-15",
        "status": "A",
        "authorized_official_last_name": "SEELMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "330-841-3540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0578343",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clin Lab",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Katelyn Meghann Fortunato, LPC
• Forum Health
• Forum Health
• Forum Health Enterprises
• Forum Health Enterprises Co
• Forum Health Pharmacy Services Co., Inc.
• Forum Health Services
• Berchindle Foster Jr.
• Jastazia M Foster
• Katrina P Foster

• Clinical Medical Laboratory in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Clinical Medical Laboratory in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.