Clinical Reference Laboratory, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

200160 Issued in KY

Legal business name

CLINICAL REFERENCE LABORATORY, INC.

Practice address

615 Chestnut St
Bowling Green, KY 42101-2200

Phone

(270) 782-8821

Fax

(270) 842-1820

NPI assigned

Aug 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Carolynn Jernigan

Title

Manager

Phone

(270) 782-8821

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1063523926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 CHESTNUT ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421012200",
            "telephone_number": "270-782-8821",
            "fax_number": "270-842-1820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 CHESTNUT ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421012200",
            "telephone_number": "270-782-8821",
            "fax_number": "270-842-1820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL REFERENCE LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "JERNIGAN",
        "authorized_official_first_name": "CAROLYNN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "270-782-8821",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "KY",
            "license": "200160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37901717",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000112997",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Clinical Medical Laboratory in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.