Provider Demographics
NPI:1407301401
Name:ST. THOMAS CLINICAL REFERENCE LABORATORY, LLC
Entity Type:Organization
Organization Name:ST. THOMAS CLINICAL REFERENCE LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-246-4698
Mailing Address - Street 1:MEDICAL COMPLEX
Mailing Address - Street 2:SUITE NO. 3 ST THOMAS
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-5735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL COMPLEX
Practice Address - Street 2:SUITE NO. 3 ST THOMAS
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-5735
Practice Address - Country:US
Practice Address - Phone:340-774-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1348871L291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory