Provider Demographics
NPI:1346725637
Name:EXCEL CLINICAL LABORATORY SERVICE
Entity Type:Organization
Organization Name:EXCEL CLINICAL LABORATORY SERVICE
Other - Org Name:ECLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT, MLS(ASCP)CM
Authorized Official - Phone:785-410-7016
Mailing Address - Street 1:3024 TAMARAK DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3125
Mailing Address - Country:US
Mailing Address - Phone:785-410-7016
Mailing Address - Fax:
Practice Address - Street 1:1133 COLLEGE AVE STE 145
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-410-7016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory