1316463367 NPI number — ANR CLINICAL LAB CORP

Table of content: (NPI 1316463367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316463367 NPI number — ANR CLINICAL LAB CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANR CLINICAL LAB CORP
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:
1316463367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14511
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00916-4511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-726-3781
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 AVE BORINQUEN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00915-3827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-726-3781
Provider Business Practice Location Address Fax Number:
787-726-3781
Provider Enumeration Date:
08/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
NEIRA
Authorized Official First Name:
ABIGAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-726-3781

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  358 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 358 . This is a "358" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 039076100 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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