1346291986 NPI number — PARKWAY CLINICAL LABORATORIES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346291986 NPI number — PARKWAY CLINICAL LABORATORIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKWAY CLINICAL LABORATORIES, 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:
1346291986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3494 PROGRESS DRIVE
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
BENSALEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19020-5815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-245-5112
Provider Business Mailing Address Fax Number:
215-245-5241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3494 PROGRESS DRIVE
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
BENSALEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19020-5815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-245-5112
Provider Business Practice Location Address Fax Number:
215-245-5241
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAIDER
Authorized Official First Name:
MASOOD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
215-245-5112

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  000250 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000250 . This is a "PA DEPT. OF HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 39D0195602 . This is a "CLIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007131410004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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