Provider Demographics
NPI:1609106756
Name:CLINICAL TESTING LABORATORIES, INC.
Entity Type:Organization
Organization Name:CLINICAL TESTING LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:CORP AGENT OF RECORD
Authorized Official - Phone:575-646-3465
Mailing Address - Street 1:3655 RESEARCH DR
Mailing Address - Street 2:MSC3ARP, BOX 30001
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003-1239
Mailing Address - Country:US
Mailing Address - Phone:575-646-3465
Mailing Address - Fax:575-646-6060
Practice Address - Street 1:3655 RESEARCH DR
Practice Address - Street 2:MSC3ARP, BOX 30001
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003-1239
Practice Address - Country:US
Practice Address - Phone:575-646-3465
Practice Address - Fax:575-646-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM32D1086620291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory