Provider Demographics
NPI:1245227727
Name:SLATER LABORATORIES INC
Entity Type:Organization
Organization Name:SLATER LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-255-4772
Mailing Address - Street 1:1013 MENOHER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2544
Mailing Address - Country:US
Mailing Address - Phone:814-255-4772
Mailing Address - Fax:814-255-4847
Practice Address - Street 1:1013 MENOHER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2544
Practice Address - Country:US
Practice Address - Phone:814-255-4772
Practice Address - Fax:814-255-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA000502291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
690409113OtherRAILROAD MEDICARE
S104398OtherHIGHMARK BLUE SHIELD
PA0007138020002Medicaid
S104398OtherHIGHMARK BLUE SHIELD
S104398OtherHIGHMARK BLUE SHIELD