SPECIALTY LABORATORIES INC

Provider Demographics

• NPI: 1811997711
• Name: SPECIALTY LABORATORIES INC
• Entity type: Organization
• Organization Name: SPECIALTY LABORATORIES INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: VICE PRESIDENT
• Authorized Official - First Name: LEAH
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: TIMMERMAN
• Authorized Official - Phone: 973-520-2700
• Mailing Address - Street 1: 14275 MIDWAY RD STE 400
• Mailing Address - City: ADDISON
• Mailing Address - State: TX
• Mailing Address - Zip Code: 75001-3661
• Mailing Address - Country: US
• Mailing Address - Phone: 866-697-8378
• Practice Address - Street 1: 8407 FALLBROOK AVE STE 100
• Practice Address - City: WEST HILLS
• Practice Address - State: CA
• Practice Address - Zip Code: 91304-3252
• Practice Address - Country: US
• Practice Address - Phone: 800-421-7110
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: QUEST DIAGNOSTICS INCORPORATED
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2005-07-21
• Last Update Date: 2024-12-16

Provider Licenses

State	License ID	Taxonomies
CA	05D0550302	291U00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	291U00000X	Laboratories	Clinical Medical Laboratory

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NE	=========01	Medicaid
NY	00804417	Medicaid
AL	009700500	Medicaid
LA	1-91908-0	Medicaid
MI	3394740	Medicaid
KY	37901386	Medicaid
OR	036962	Medicaid
KS	100245680A	Medicaid
IN	200130130A	Medicaid
ME	194150000	Medicaid
NE	=========01	Medicaid
SD	5580230	Medicaid
NM	90662	Medicaid
UT	TIN	Medicaid
PA	01617471	Medicaid
NJ	4061900	Medicaid
MO	708674007	Medicaid
FL	030587100	Medicaid
DC	0409830	Medicaid
WV	6705140-000	Medicaid
MA	6800734	Medicaid
WA	7253909	Medicaid
CO	96000813	Medicaid
NC	7001150	Medicaid
MS	00118553	Medicaid
CT	003045564	Medicaid
TX	071681301	Medicaid
MD	27232800	Medicaid
HI	53957001	Medicaid
AK	LB0554C	Medicaid
ND	017585	Medicaid
ID	003516300	Medicaid
OH	0507866	Medicaid
VA	0591033	Medicaid
WI	32905500	Medicaid
AZ	003103	Medicaid
OK	100759460A	Medicaid
AR	108909709	Medicaid
IA	0989343	Medicaid
WY	108633200	Medicaid
MN	386718800	Medicaid
MT	420030	Medicaid
SC	L00008	Medicaid
CA	LAB02586F	Medicaid
UT	TIN	Medicaid