Provider Demographics
NPI:1023024643
Name:WILKESBORO CLINICAL LAB LLC
Entity Type:Organization
Organization Name:WILKESBORO CLINICAL LAB LLC
Other - Org Name:WILKESBORO CLINICAL LAB LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:CURTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-838-7609
Mailing Address - Street 1:1201 SCHOOL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2629
Mailing Address - Country:US
Mailing Address - Phone:336-838-7609
Mailing Address - Fax:336-838-7807
Practice Address - Street 1:1201 SCHOOL ST
Practice Address - Street 2:SUITE A
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2629
Practice Address - Country:US
Practice Address - Phone:336-838-7609
Practice Address - Fax:336-838-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34D0958992291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D0958992OtherCLIA LICENSE
NC7001175Medicaid
NC2552633Medicare PIN