NPIMap

Organization Active NPI

Laboratory Corporation of America Holdings

  • Clinical Medical Laboratory
  • Brunswick, GA
National Provider Identifier
1295718476
Registry record updated Aug 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
LABORATORY CORPORATION OF AMERICA HOLDINGS
Practice address
2436 Parkwood Dr
Brunswick, GA 31520-4721
Phone
(912) 267-6110
NPI assigned
Nov 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2007

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

Authorized official

Name
William B Hayes
Title
Cfo/Evp/ Treasurer
Phone
(800) 222-7566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

2436 Parkwood Dr
Brunswick, GA 31520-4721

Mailing address

PO Box 2240
Burlington, NC 27216-2240
Phone (800) 222-7566

Other identifiers 1

IdentifierTypeStateIssuer
00868568AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040714000627 GA Part B Supplier - Independent Clinical Laboratory 8729991757 18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cumming, GA; Gainesville, GA; Tucker, GA; Albany, GA

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

National Provider Directory

National Provider Directory

Locations

2436 Parkwood Dr
Brunswick, GA 31520
Phone (912) 267-6110

NPI Registry JSON

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187308800000",
    "number": "1295718476",
    "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",
            "telephone_number": "800-222-7566",
            "fax_number": "336-436-1048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2436 PARKWOOD DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204721",
            "telephone_number": "912-267-6110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORY CORPORATION OF AMERICA HOLDINGS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-22",
        "last_updated": "2007-08-17",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CFO/EVP/ TREASURER",
        "authorized_official_telephone_number": "800-222-7566"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00868568A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.