1871852905 NPI number — JOSHUA CLINICAL LABORATORIES,LLC

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 1871852905 NPI number — JOSHUA CLINICAL LABORATORIES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSHUA CLINICAL LABORATORIES,LLC
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:
1871852905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7365
Provider Second Line Business Mailing Address:
4805 SOUTH 25TH STREET
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68107-0365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-731-7333
Provider Business Mailing Address Fax Number:
402-614-5405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4805 S 25TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68107-2797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-731-7333
Provider Business Practice Location Address Fax Number:
402-614-5405
Provider Enumeration Date:
05/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KERSHNER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
402-731-7333

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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