Provider Demographics
NPI:1477556876
Name:MERIDIAN LABORATORY CORP
Entity Type:Organization
Organization Name:MERIDIAN LABORATORY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MT(ASCP)
Authorized Official - Phone:704-992-0708
Mailing Address - Street 1:2401 WHITEHALL PARK DRIVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3416
Mailing Address - Country:US
Mailing Address - Phone:704-992-0708
Mailing Address - Fax:704-749-2332
Practice Address - Street 1:2401 WHITEHALL PARK DRIVE
Practice Address - Street 2:SUITE 700
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3416
Practice Address - Country:US
Practice Address - Phone:704-992-0708
Practice Address - Fax:704-749-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34D0999131291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7001198Medicaid
NC2552664Medicare ID - Type UnspecifiedMEDIACARE