Provider Demographics
NPI:1679787980
Name:CLINICAL LABORATORY, INC.
Entity Type:Organization
Organization Name:CLINICAL LABORATORY, INC.
Other - Org Name:ST. CROIX CLINICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COURSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-778-5369
Mailing Address - Street 1:PO BOX 5226
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5226
Mailing Address - Country:US
Mailing Address - Phone:340-778-5369
Mailing Address - Fax:340-778-8573
Practice Address - Street 1:ISLAND MEDICAL CENTER
Practice Address - Street 2:SUITE 6
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-5369
Practice Address - Fax:340-778-8573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48D0699866291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI030911Medicare ID - Type UnspecifiedMEDICARE PROVIDER