Provider Demographics
NPI:1356425045
Name:COMMUNITY MEDICAL LABORATORY, INC.
Entity type:Organization
Organization Name:COMMUNITY MEDICAL LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:BEHM
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-776-7444
Mailing Address - Street 1:PO BOX 7997
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-0997
Mailing Address - Country:US
Mailing Address - Phone:340-776-7444
Mailing Address - Fax:430-776-7124
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:PARAGON MEDICAL BUILDING, SUITE 102
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2687
Practice Address - Country:US
Practice Address - Phone:340-776-7444
Practice Address - Fax:430-776-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI48D0922328291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0031158Medicare ID - Type UnspecifiedPROVIDER NUMBER