Provider Demographics
NPI:1942464706
Name:ALLIED LABORATORIES, INC.
Entity Type:Organization
Organization Name:ALLIED LABORATORIES, INC.
Other - Org Name:ALLIED MEDICAL LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:BLD
Authorized Official - Phone:650-335-8336
Mailing Address - Street 1:453 RAVENDALE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-5221
Mailing Address - Country:US
Mailing Address - Phone:650-335-8336
Mailing Address - Fax:650-390-9011
Practice Address - Street 1:453 RAVENDALE DR STE B
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-5221
Practice Address - Country:US
Practice Address - Phone:650-335-8336
Practice Address - Fax:650-390-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 21291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ30615ZOtherMEDICARE PIN (INACTIVE)
05D0605512OtherCENTER FOR MEDICARE AND MEDICAID SERVICE: CLIA
CAZZZ30615ZOtherMEDICAID (INACTIVE)