1659364784 NPI number — SPECIALTY LABORATORIES, INC.

Table of content: (NPI 1659364784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659364784 NPI number — SPECIALTY LABORATORIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALTY LABORATORIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MISSION PHARMACAL
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659364784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7111 FAIRWAY DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33418-4204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-712-6265
Provider Business Mailing Address Fax Number:
561-712-7349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 E DURANGO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78210-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-581-0574
Provider Business Practice Location Address Fax Number:
210-581-1456
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GREENE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, MANAGED CARE
Authorized Official Telephone Number:
214-932-8270

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0028276B , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7001173 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: LOCL81784 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98800089 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01648843 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0805777 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000420325 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10031209A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 424507 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 741041775001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00085 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2046360 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0511352 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1540056 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00738845A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XLAB01421 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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