1346261518 NPI number — C&K LAB SERVICES, INC.

Table of content: (NPI 1346261518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346261518 NPI number — C&K LAB SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C&K LAB SERVICES, 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:
6
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:
1346261518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3923 WARING ROAD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92056-4457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-724-9231
Provider Business Mailing Address Fax Number:
760-724-0670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3923 WARING ROAD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-4457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-724-9231
Provider Business Practice Location Address Fax Number:
760-724-0670
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLSON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
562-906-5227

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF 11198 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: CLF11198 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CLF11198 . This is a "LABORATORY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CLF 11198 . This is a "LABORATORY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0915223 . This is a "CLIA NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: LAB15223F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 246200 . This is a "PIN NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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