Southeast Community Laboratory Network, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SOUTHEAST COMMUNITY LABORATORY NETWORK, LLC

Doing business as

Southeast Community Laboratory Network

Practice address

22240 County Road 39
La Salle, CO 80645-8727

Phone

(970) 663-5631

NPI assigned

Jul 5, 2016

Organization subpart

No

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

Authorized official

Name

Daryl Bohlender

Title

Coo

Phone

(970) 663-5631

Specialties & licenses 1

Addresses

Other names 1

• Southeast Community Laboratory Network Doing business as

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

{
    "created_epoch": "1467676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467676800000",
    "number": "1083066823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22240 COUNTY ROAD 39",
            "city": "LA SALLE",
            "state": "CO",
            "postal_code": "806458727",
            "telephone_number": "970-663-5631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22240 COUNTY ROAD 39",
            "city": "LA SALLE",
            "state": "CO",
            "postal_code": "806458727",
            "telephone_number": "970-663-5631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST COMMUNITY LABORATORY NETWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-05",
        "last_updated": "2016-07-05",
        "status": "A",
        "authorized_official_last_name": "BOHLENDER",
        "authorized_official_first_name": "DARYL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "970-663-5631"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Community Laboratory Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria Pravata
• Kaley Allison Rodrigues, OTR/L
• Tabetha L Rundle, PTA
• Isabelle Amy Rusden, DDS
• Victoria Kirsten Sandelin, OTR/L
• Shay Stiles
• Samantha Maureen Vannest, LMT
• Jordan Wagner
• Gavin Christopher Whitman, DDS
• Zero Gravity Health LTD

• Clinical Medical Laboratory in La Salle, CO
• Providers in La Salle, CO by specialty
• Clinical Medical Laboratory in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; 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.