Provider Demographics
NPI:1700844339
Name:CARRIAGEWAY L P
Entity Type:Organization
Organization Name:CARRIAGEWAY L P
Other - Org Name:BIOMEDICAL LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-759-8334
Mailing Address - Street 1:4504 LOGAN WAY
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425
Mailing Address - Country:US
Mailing Address - Phone:330-759-8334
Mailing Address - Fax:330-759-0780
Practice Address - Street 1:4504 LOGAN WAY
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425
Practice Address - Country:US
Practice Address - Phone:330-759-8334
Practice Address - Fax:330-759-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450266Medicaid
OH0450266Medicaid