Provider Demographics
NPI:1871238709
Name:UNITED CLINICAL LAB LLC
Entity Type:Organization
Organization Name:UNITED CLINICAL LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAIFIDEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-455-1444
Mailing Address - Street 1:4859 DOVER CENTER RD STE 12
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3189
Mailing Address - Country:US
Mailing Address - Phone:440-455-1444
Mailing Address - Fax:
Practice Address - Street 1:4859 DOVER CENTER RD STE 12
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3189
Practice Address - Country:US
Practice Address - Phone:440-455-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36D2257969OtherCLIA