Provider Demographics
NPI:1164835823
Name:CENTRAL MEDICAL LABORATORY, LLC
Entity Type:Organization
Organization Name:CENTRAL MEDICAL LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-343-2718
Mailing Address - Street 1:8960 COMMERCE DR
Mailing Address - Street 2:BUILDING 6
Mailing Address - City:DE SOTO
Mailing Address - State:KS
Mailing Address - Zip Code:66018
Mailing Address - Country:US
Mailing Address - Phone:804-343-2718
Mailing Address - Fax:
Practice Address - Street 1:8960 COMMERCE DR
Practice Address - Street 2:BUILDING 6
Practice Address - City:DE SOTO
Practice Address - State:KS
Practice Address - Zip Code:66018
Practice Address - Country:US
Practice Address - Phone:804-343-2718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH DIAGNOSTIC LABORATORY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-10
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17D1089651291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory