Provider Demographics
NPI:1124038930
Name:MERIDIAN CLINICAL LABORATORY, CORP
Entity Type:Organization
Organization Name:MERIDIAN CLINICAL LABORATORY, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO; EXECUTIVE VP
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ERDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-791-2600
Mailing Address - Street 1:481 EDWARD H ROSS DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-3118
Mailing Address - Country:US
Mailing Address - Phone:201-791-2600
Mailing Address - Fax:201-791-1941
Practice Address - Street 1:300 SW 107TH AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3600
Practice Address - Country:US
Practice Address - Phone:305-554-9790
Practice Address - Fax:305-228-8387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIO-REFERENCE LABORATORIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-08
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800015640291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030671100Medicaid
FLE9063Medicare ID - Type UnspecifiedINDEPENDENT LAB