Provider Demographics
NPI:1760469076
Name:GARCIA CLINICAL LABORATORY INC
Entity Type:Organization
Organization Name:GARCIA CLINICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-787-9200
Mailing Address - Street 1:2195 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2797
Mailing Address - Country:US
Mailing Address - Phone:517-787-9200
Mailing Address - Fax:517-787-1249
Practice Address - Street 1:2195 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2797
Practice Address - Country:US
Practice Address - Phone:517-787-9200
Practice Address - Fax:517-787-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI690C81502OtherBCBS OF MICHIGAN ID
MI3520001OtherPHYSICIANS HEALTH PLAN
MI690C81502OtherBCBS OF MICHIGAN ID
MI690C81502OtherBCBS OF MICHIGAN ID