Provider Demographics
NPI:1558745422
Name:UNITED CLINICAL LABORATORY LLC
Entity type:Organization
Organization Name:UNITED CLINICAL LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:VESSELOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-291-4292
Mailing Address - Street 1:2257 VISTA PARKWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:844-291-4292
Mailing Address - Fax:561-616-9087
Practice Address - Street 1:2257 VISTA PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2724
Practice Address - Country:US
Practice Address - Phone:844-291-4292
Practice Address - Fax:561-616-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory