Provider Demographics
NPI:1881977866
Name:CHOICE CLINICAL LAB, LLC
Entity type:Organization
Organization Name:CHOICE CLINICAL LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:URALIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-805-4406
Mailing Address - Street 1:2329 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4713
Mailing Address - Country:US
Mailing Address - Phone:972-428-7211
Mailing Address - Fax:972-428-7216
Practice Address - Street 1:2329 PARKER RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4713
Practice Address - Country:US
Practice Address - Phone:972-428-7211
Practice Address - Fax:972-428-7216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory