1124117890 NPI number — CLINICAL SCIENCE LABORATORY INC.

Table of content: (NPI 1124117890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124117890 NPI number — CLINICAL SCIENCE LABORATORY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL SCIENCE 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:
1124117890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 347
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02048-0347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-339-6106
Provider Business Mailing Address Fax Number:
508-339-3540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 FRANCIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02048-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-339-6106
Provider Business Practice Location Address Fax Number:
508-339-3540
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELFBAUM
Authorized Official First Name:
STANLEY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-339-6106

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  5488 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0802298 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAP#113890 . This is a "COLLEGE AMER PATHOLOGISTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22D007402 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30004689 . This is a "DEPT OF HEALTH NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 00180 . This is a "DEPT OF HEALTH RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 024916 . This is a "DEPT OF HEALTH PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PFI8096 . This is a "DEPT OF HEALTH NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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