Provider Demographics
NPI:1790028157
Name:COMPUNET CLINICAL LABORATORIES, LLC
Entity Type:Organization
Organization Name:COMPUNET CLINICAL LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-297-8202
Mailing Address - Street 1:2308 SANDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1847
Mailing Address - Country:US
Mailing Address - Phone:937-297-8253
Mailing Address - Fax:937-297-8254
Practice Address - Street 1:2300 MIAMI VALLEY DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4779
Practice Address - Country:US
Practice Address - Phone:937-312-1585
Practice Address - Fax:937-312-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory