1881937373 NPI number — CORRLABS, 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 1881937373 NPI number — CORRLABS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORRLABS, 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:
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:
1881937373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 COMMERCE AVENUE
Provider Second Line Business Mailing Address:
UNIT 10
Provider Business Mailing Address City Name:
SOUTHERN PINES
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28387-7115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-294-0099
Provider Business Mailing Address Fax Number:
910-637-0004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 COMMERCE AVENUE
Provider Second Line Business Practice Location Address:
UNIT 10
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28387-7115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-294-0099
Provider Business Practice Location Address Fax Number:
910-637-0004
Provider Enumeration Date:
04/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CORRIGAN
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
910-294-0099

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  191175 , 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: 1881937373 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00401 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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