Provider Demographics
NPI:1316573827
Name:SUMMIT CLINICAL LABORATORIES LLC
Entity Type:Organization
Organization Name:SUMMIT CLINICAL LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:O'BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-248-3601
Mailing Address - Street 1:21755 GATEWAY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5137
Mailing Address - Country:US
Mailing Address - Phone:262-788-9311
Mailing Address - Fax:262-788-9203
Practice Address - Street 1:21755 GATEWAY RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5137
Practice Address - Country:US
Practice Address - Phone:262-788-9311
Practice Address - Fax:262-788-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory