1477556876 NPI number — MERIDIAN LABORATORY CORP

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 1477556876 NPI number — MERIDIAN LABORATORY CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIDIAN LABORATORY 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:
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:
1477556876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 WHITEHALL PARK DRIVE
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28273-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-992-0708
Provider Business Mailing Address Fax Number:
704-749-2332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 WHITEHALL PARK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28273-3416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-992-0708
Provider Business Practice Location Address Fax Number:
704-749-2332
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SADLER
Authorized Official First Name:
MARGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VP OPERATIONS
Authorized Official Telephone Number:
704-992-0708

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  34D0999131 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7001198 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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