Provider Demographics
NPI:1073534145
Name:BIO-TECH CLINICAL LABORATORIES, INC
Entity Type:Organization
Organization Name:BIO-TECH CLINICAL LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-367-1220
Mailing Address - Street 1:9000 NW 15TH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2909
Mailing Address - Country:US
Mailing Address - Phone:305-267-1220
Mailing Address - Fax:786-388-8034
Practice Address - Street 1:9000 NW 15TH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2909
Practice Address - Country:US
Practice Address - Phone:305-267-1220
Practice Address - Fax:786-388-8034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800014740291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D0965332OtherCLIA ID NUMBER
FL800014740OtherSTATE OF FLORIDA
FLL9210OtherBCBS
FL103547500Medicaid
FL291U00000XOtherTAXONOMY
FL030645200Medicaid