Provider Demographics
NPI:1013254416
Name:COMPUNET CLINICAL LABORATORIES, LLC
Entity Type:Organization
Organization Name:COMPUNET CLINICAL LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-297-8202
Mailing Address - Street 1:2308 SANDRIDGE DR
Mailing Address - Street 2:ATTN: CINDY ALEXANDER
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1847
Mailing Address - Country:US
Mailing Address - Phone:937-297-8253
Mailing Address - Fax:937-297-8254
Practice Address - Street 1:725 S LUDLOW ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2610
Practice Address - Country:US
Practice Address - Phone:937-208-8809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D2044001 - CLIA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory