Provider Demographics
NPI:1710589031
Name:UNITED DIAGNOSTIC LABORATORIES LLC
Entity Type:Organization
Organization Name:UNITED DIAGNOSTIC LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:CONTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-816-0343
Mailing Address - Street 1:302 POMONA DR STE K
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1642
Mailing Address - Country:US
Mailing Address - Phone:336-370-9232
Mailing Address - Fax:
Practice Address - Street 1:302 POMONA DR STE K
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1642
Practice Address - Country:US
Practice Address - Phone:336-370-9232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory