Provider Demographics
NPI:1083117535
Name:QUALITY CLINICAL LAB LLC
Entity Type:Organization
Organization Name:QUALITY CLINICAL LAB LLC
Other - Org Name:EXPRESS LABORATORY SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-334-9234
Mailing Address - Street 1:PO BOX 1561
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-1561
Mailing Address - Country:US
Mailing Address - Phone:813-334-9234
Mailing Address - Fax:
Practice Address - Street 1:2204 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-4351
Practice Address - Country:US
Practice Address - Phone:813-334-9234
Practice Address - Fax:813-334-9234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXPRESS LABORATORY SERVICES , INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-12
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty