1801851233 NPI number — WOODBURY CLINICAL LABORATORY, INC.

Table of content: (NPI 1801851233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801851233 NPI number — WOODBURY CLINICAL LABORATORY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODBURY CLINICAL LABORATORY, 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:
1801851233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37088-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-443-7588
Provider Business Mailing Address Fax Number:
615-443-7458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37087-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-443-7588
Provider Business Practice Location Address Fax Number:
615-443-7458
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLDHAM
Authorized Official First Name:
DELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
615-443-7588

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  0000002135 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000002135 . This is a "STATE MEDICAL LABORATORY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 44D0659026 . This is a "CLIA CERTIFICATE OF COMPL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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