Provider Demographics
NPI:1902826381
Name:CALLOWAY LABORATORIES INC.
Entity Type:Organization
Organization Name:CALLOWAY LABORATORIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-224-9899
Mailing Address - Street 1:12 GILL ST
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1765
Mailing Address - Country:US
Mailing Address - Phone:781-224-9899
Mailing Address - Fax:781-224-2423
Practice Address - Street 1:12 GILL ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1765
Practice Address - Country:US
Practice Address - Phone:781-224-9899
Practice Address - Fax:781-224-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22D107579291U00000X
MA3294291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408740200Medicaid
NH609588Medicaid
GA612379401AMedicaid
CO13255371Medicaid
AL690000029Medicaid
PA1012731860001Medicaid
OH2555391Medicaid
CT003123106Medicaid
FL100505833Medicaid
VT1012456Medicaid
AZ941593Medicaid
MA0800139Medicaid
NV2555391Medicaid
SCL00205Medicaid
NJ0097098Medicaid
ME416390000Medicaid
CT003123106Medicaid