Provider Demographics
NPI:1871836262
Name:CLINICAL LABORATORY SERVICES OF MANATI, INC.
Entity Type:Organization
Organization Name:CLINICAL LABORATORY SERVICES OF MANATI, INC.
Other - Org Name:LABORATORIO CLINICO MEDI SERV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:APA
Authorized Official - Phone:787-881-2700
Mailing Address - Street 1:PO BOX 2387
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-2387
Mailing Address - Country:US
Mailing Address - Phone:787-881-2700
Mailing Address - Fax:787-879-0358
Practice Address - Street 1:CARR #2 KM. 70.2
Practice Address - Street 2:BO. DOMINGO RUIZ
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0477
Practice Address - Country:US
Practice Address - Phone:787-881-2700
Practice Address - Fax:787-879-0358
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 Licenses
StateLicense IDTaxonomies
PR536291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCC278AOtherPTAN