Provider Demographics
NPI:1164598041
Name:CROSS MEDICAL LABORATORIES LLP
Entity Type:Organization
Organization Name:CROSS MEDICAL LABORATORIES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAVEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-7284
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:321 E MARKET ST, SUITE 102
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-1390
Mailing Address - Country:US
Mailing Address - Phone:319-337-7284
Mailing Address - Fax:319-337-7284
Practice Address - Street 1:321 E MARKET ST STE 102
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2176
Practice Address - Country:US
Practice Address - Phone:319-337-7284
Practice Address - Fax:319-337-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0002436Medicaid
IA0002436Medicaid