Provider Demographics
NPI: | 1952892119 |
---|---|
Name: | LABORATORY CORPORATION OF AMERICA HOLDINGS |
Entity Type: | Organization |
Organization Name: | LABORATORY CORPORATION OF AMERICA HOLDINGS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VICE PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KIMBERLY |
Authorized Official - Middle Name: | T |
Authorized Official - Last Name: | WILLIAMS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 336-436-5402 |
Mailing Address - Street 1: | PO BOX 2240 |
Mailing Address - Street 2: | |
Mailing Address - City: | BURLINGTON |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27216-2240 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 719 GREEN VALLEY RD STE 101 |
Practice Address - Street 2: | |
Practice Address - City: | GREENSBORO |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27408-7022 |
Practice Address - Country: | US |
Practice Address - Phone: | 336-790-2989 |
Practice Address - Fax: | 336-230-2178 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-05-23 |
Last Update Date: | 2018-05-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
34D2144206 | Other | CLIA |