Provider Demographics
NPI:1598112427
Name:CORE BIOTECH SYSTEMS
Entity Type:Organization
Organization Name:CORE BIOTECH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY GENERAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MLS (ASCP)
Authorized Official - Phone:601-540-6974
Mailing Address - Street 1:1325 S KILLIAN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1965
Mailing Address - Country:US
Mailing Address - Phone:561-508-8194
Mailing Address - Fax:561-847-4466
Practice Address - Street 1:1325 S KILLIAN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-1965
Practice Address - Country:US
Practice Address - Phone:561-508-8194
Practice Address - Fax:561-847-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory