Provider Demographics
NPI:1700528858
Name:EASTERN LABORATORY ASSOCIATES
Entity Type:Organization
Organization Name:EASTERN LABORATORY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GODARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS,BSMT,MLT(ASCP)
Authorized Official - Phone:252-364-8681
Mailing Address - Street 1:2470 EMERALD PL STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5786
Mailing Address - Country:US
Mailing Address - Phone:252-364-8681
Mailing Address - Fax:252-364-8682
Practice Address - Street 1:2470 EMERALD PL STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5786
Practice Address - Country:US
Practice Address - Phone:252-364-8681
Practice Address - Fax:252-364-8682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory