Provider Demographics
NPI:1669686762
Name:UNIQUE CLINICAL LABORATORY, INC
Entity Type:Organization
Organization Name:UNIQUE CLINICAL LABORATORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GRIGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURNAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-570-1162
Mailing Address - Street 1:4020 PALMER PARK BLVD
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3402
Mailing Address - Country:US
Mailing Address - Phone:719-570-1162
Mailing Address - Fax:719-570-1155
Practice Address - Street 1:4020 PALMER PARK BLVD
Practice Address - Street 2:SUITE 103B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3402
Practice Address - Country:US
Practice Address - Phone:719-570-1162
Practice Address - Fax:719-570-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory