Provider Demographics
NPI:1235294034
Name:GULF COAST REFERENCE LABORATORIES INC
Entity Type:Organization
Organization Name:GULF COAST REFERENCE LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-849-5075
Mailing Address - Street 1:5354 GULF DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3920
Mailing Address - Country:US
Mailing Address - Phone:727-847-0006
Mailing Address - Fax:727-847-4589
Practice Address - Street 1:5354 GULF DRIVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3920
Practice Address - Country:US
Practice Address - Phone:727-847-0006
Practice Address - Fax:727-847-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
L8608Medicare ID - Type Unspecified