Provider Demographics
NPI:1538508551
Name:CENTRAL CLINICAL LABORATORIES LLC
Entity Type:Organization
Organization Name:CENTRAL CLINICAL LABORATORIES LLC
Other - Org Name:CENTRAL CLINICAL LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-547-1619
Mailing Address - Street 1:1322 SPACE PARK DR
Mailing Address - Street 2:SUITE A195
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3400
Mailing Address - Country:US
Mailing Address - Phone:913-547-1619
Mailing Address - Fax:888-355-5137
Practice Address - Street 1:1322 SPACE PARK DR
Practice Address - Street 2:SUITE A195
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3400
Practice Address - Country:US
Practice Address - Phone:913-547-1619
Practice Address - Fax:888-355-5137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL CLINICAL LABORATORIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-24
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2052244291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2052244OtherCLIA