Provider Demographics
NPI:1083933964
Name:CLINICAL REFERENCE LABORATORY, INC.
Entity Type:Organization
Organization Name:CLINICAL REFERENCE LABORATORY, INC.
Other - Org Name:INSURANCE LAB SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-492-3652
Mailing Address - Street 1:8433 QUIVIRA RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2802
Mailing Address - Country:US
Mailing Address - Phone:913-492-3652
Mailing Address - Fax:913-693-1597
Practice Address - Street 1:8433 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2802
Practice Address - Country:US
Practice Address - Phone:913-492-3652
Practice Address - Fax:913-693-1597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICAL REFERENCE LABORATORY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17D0667123291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory