Provider Demographics
NPI:1497278816
Name:CLINICAL LABORATORY SERVICES OF MANATI, INC
Entity Type:Organization
Organization Name:CLINICAL LABORATORY SERVICES OF MANATI, INC
Other - Org Name:LABORATORIO CLINICO MANATI II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:APA
Authorized Official - Phone:787-432-1376
Mailing Address - Street 1:PO BOX 2387
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-2387
Mailing Address - Country:US
Mailing Address - Phone:787-884-5886
Mailing Address - Fax:787-884-5886
Practice Address - Street 1:MARGINAL B19
Practice Address - Street 2:URB FLAMBOYAN
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-5660
Practice Address - Fax:787-884-0084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICAL LABORATORY SERVICES OF MANATI, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR684291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCC278AMedicaid