Laboratory Corporation of America Holdings
Organization Active NPI Clinical Medical Laboratory · South Charleston, WV
NPI 1003290644 · NPPES record last updated Jul 14, 2015
Key facts
- NPI
- 1003290644
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Legal business name
- LABORATORY CORPORATION OF AMERICA HOLDINGS
- Practice address
- 4803 Kentucky St
South Charleston, WV 25309-1309 - Phone
- (304) 766-9556
- NPI assigned
- Jul 14, 2015
- Organization subpart
- No
Authorized official
- Name
- Kimberly Williams
- Title
- Vice President
- Phone
- (800) 222-7566
Other NPIs on the same Medicare enrollment 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041124000555 | WV | Part B Supplier - Independent Clinical Laboratory | 8729991757 |
7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Charleston, WV; Princeton, WV |
National Provider Directory
Networks
- HealthSun Health Plans Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
4803 Kentucky St
South Charleston, WV 25309-1309
Mailing address
PO Box 2240
Burlington, NC 27216-2240
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51D2098721 | Other | CLIA |
NPI Registry JSON
{
"created_epoch": "1436832000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1436832000000",
"number": "1003290644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2240",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272162240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4803 KENTUCKY ST",
"city": "SOUTH CHARLESTON",
"state": "WV",
"postal_code": "253091309",
"telephone_number": "304-766-9556"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LABORATORY CORPORATION OF AMERICA HOLDINGS",
"organizational_subpart": "NO",
"enumeration_date": "2015-07-14",
"last_updated": "2015-07-14",
"status": "A",
"authorized_official_last_name": "WILLIAMS",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "800-222-7566"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA",
"identifier": "51D2098721",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in South Charleston, WV
- Jayakrishna Uppoor Kukkillaya
- Amber Kuntz
- Natasha Denese Kurtz
- Kuruvilla John, MD, Inc.
- Paul Timothy Kuryla
- Teresa Teann Lacy
- Jodi Lafferty
- Gregory T. Lagos
- Sharon G. Lake
- Terry L Lake
All providers in South Charleston, WV · Clinical Medical Laboratory in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.