Provider Demographics
NPI:1952619983
Name:CORINTHIAN REFERENCE LAB LLC
Entity Type:Organization
Organization Name:CORINTHIAN REFERENCE LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:940-733-5206
Mailing Address - Street 1:6201 SOUTHWEST BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1068
Mailing Address - Country:US
Mailing Address - Phone:817-731-3337
Mailing Address - Fax:817-731-3387
Practice Address - Street 1:6201 SOUTHWEST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132-1068
Practice Address - Country:US
Practice Address - Phone:817-731-3337
Practice Address - Fax:817-731-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory