Provider Demographics
NPI:1265877542
Name:CENTRAL MEDICAL LABORATORY, INC.
Entity type:Organization
Organization Name:CENTRAL MEDICAL LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/ DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHATFIELD
Authorized Official - Last Name:HISERODT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-743-5253
Mailing Address - Street 1:2601 N 3RD ST
Mailing Address - Street 2:SUITE# 218
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1104
Mailing Address - Country:US
Mailing Address - Phone:602-626-5360
Mailing Address - Fax:602-626-5943
Practice Address - Street 1:2601 N 3RD ST
Practice Address - Street 2:SUITE# 218
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1104
Practice Address - Country:US
Practice Address - Phone:602-626-5360
Practice Address - Fax:602-626-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory