Provider Demographics
NPI:1376822585
Name:LABORATORIO CLINICO VAN SCOY INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO VAN SCOY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-644-0617
Mailing Address - Street 1:RR 8 BOX 1995 MSC 178
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9613
Mailing Address - Country:US
Mailing Address - Phone:787-251-0138
Mailing Address - Fax:787-251-0130
Practice Address - Street 1:AA 4 AVENIDA DON PELAYO
Practice Address - Street 2:HACIENDA DEL NORTE
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-251-0138
Practice Address - Fax:787-251-0130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO VAN SCOY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-05
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0031334Medicare PIN