Provider Demographics
NPI:1982193330
Name:SUPERIOR CLINICAL LABS, LLC
Entity Type:Organization
Organization Name:SUPERIOR CLINICAL LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-647-7404
Mailing Address - Street 1:7685 103RD ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-9326
Mailing Address - Country:US
Mailing Address - Phone:904-647-7404
Mailing Address - Fax:
Practice Address - Street 1:7685 103RD ST STE 1A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-9326
Practice Address - Country:US
Practice Address - Phone:904-647-7404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory