1295773380 NPI number — COMMONWEALTH MEDICAL LABS INC.

Table of content: (NPI 1295773380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295773380 NPI number — COMMONWEALTH MEDICAL LABS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH MEDICAL LABS 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:
1295773380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4228 AIKEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20187-3931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-428-2909
Provider Business Mailing Address Fax Number:
540-428-2905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4228 AIKEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20187-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-428-2909
Provider Business Practice Location Address Fax Number:
540-428-2905
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRATT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
540-428-2909

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  49D0661031 , 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: 0517383 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805782200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00366099A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0122009 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100027530A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 690008904 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 706118908 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 465710 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7001088 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009801680 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114211709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35460 . This is a "SOUTHERN HEALTH SVCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0724056-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1537527 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37901907 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004980832 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0899167 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000420359 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 923-19860 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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