Provider Demographics
NPI:1598106163
Name:CENTRAL CLINICAL LABS INCORPORATED
Entity Type:Organization
Organization Name:CENTRAL CLINICAL LABS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AYAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-202-9840
Mailing Address - Street 1:3720 E LA SALLE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3976
Mailing Address - Country:US
Mailing Address - Phone:480-990-1335
Mailing Address - Fax:490-990-1337
Practice Address - Street 1:3720 E LA SALLE ST STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-3976
Practice Address - Country:US
Practice Address - Phone:480-990-1335
Practice Address - Fax:490-990-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ161509OtherMEDICARE
AZ845461Medicaid
AZP01308159OtherMEDICARE RAILROAD PTAN