Provider Demographics
NPI:1346261518
Name:C&K LAB SERVICES, INC.
Entity Type:Organization
Organization Name:C&K LAB SERVICES, INC.
Other - Org Name:BIO TECH CLINICAL SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-906-5227
Mailing Address - Street 1:3923 WARING ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4457
Mailing Address - Country:US
Mailing Address - Phone:760-724-9231
Mailing Address - Fax:760-724-0670
Practice Address - Street 1:3923 WARING ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4457
Practice Address - Country:US
Practice Address - Phone:760-724-9231
Practice Address - Fax:760-724-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 11198291U00000X
CACLF11198291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF11198OtherLABORATORY LICENSE
CACLF 11198OtherLABORATORY LICENSE
CA05D0915223OtherCLIA NUMBER
CALAB15223FMedicaid
CA246200OtherPIN NUMBER
CA05D09215223Medicare UPIN
CA246200OtherPIN NUMBER