1063477123 NPI number — UNITED MEDICAL LABORATORIES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063477123 NPI number — UNITED MEDICAL LABORATORIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED MEDICAL 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:
Provider Other Organization Name Type Code:
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:
1063477123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1980 GALLOWS RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
TYSONS CORNER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22182-3913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-356-4422
Provider Business Mailing Address Fax Number:
703-356-2460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1980 GALLOWS RD
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
TYSONS CORNER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22182-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-356-4422
Provider Business Practice Location Address Fax Number:
703-356-2460
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHANG
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
703-356-4422

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  417 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004980743 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0312387 00 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 275360 . This is a "BC/BS, ANTHEM (RICHMOND)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: K093-0001 . This is a "BC/BS, CAREFIRST, FEP" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 275359 . This is a "BC/BS, ANTHEM, FEP (RICHMOND)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 469178400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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