Provider Demographics
NPI:1225481724
Name:UNIVERSAL CLINICAL LABORATORIES LLC
Entity Type:Organization
Organization Name:UNIVERSAL CLINICAL LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-566-2075
Mailing Address - Street 1:87 S COMMERCE WAY
Mailing Address - Street 2:STE 700
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017
Mailing Address - Country:US
Mailing Address - Phone:484-553-5818
Mailing Address - Fax:267-358-5979
Practice Address - Street 1:87 S COMMERCE WAY
Practice Address - Street 2:STE 700
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:484-553-5818
Practice Address - Fax:267-358-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory