Laboratory Corporation of America
Organization Active NPI Clinical Medical Laboratory · Traverse City, MI
NPI 1336720671 · NPPES record last updated Apr 28, 2021
Key facts
- NPI
- 1336720671
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Legal business name
- LABORATORY CORPORATION OF AMERICA
- Practice address
- 4290 Copper Ridge Dr Ste 120
Traverse City, MI 49684-7205 - Phone
- (855) 841-0475
- Fax
- (248) 888-9039
- NPI assigned
- Apr 19, 2021
- Organization subpart
- No
Authorized official
- Name
- Kimberly T Williams
- Title
- Vice President
- Phone
- (800) 222-7566
Other NPIs on the same Medicare enrollment 8
Corporate family (same tax ID) 6
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2219162 | Laboratory Corporation of America | Certificate of waiver | Mar 13, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050701000342 | MI | Part B Supplier - Independent Clinical Laboratory | 2668379025 |
8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Troy, MI; Traverse City, MI; East Jordan, MI; Bellaire, MI |
National Provider Directory
- Tax ID family
- Reference Pathology Lab
Locations
4290 Copper Ridge Dr
Ste 120
Traverse City, MI 49684
Phone (855) 841-0475
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
4290 Copper Ridge Dr Ste 120
Traverse City, MI 49684-7205
Mailing address
PO Box 2240
Burlington, NC 27216-2240
Phone (336) 436-5884
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23D2219162 | Other | CLIA |
Other providers in Traverse City, MI
- Janice Sue Kwiatkowski
- Jeffrey V Kyff
- Mary Beth Kyro
- Chelsea La Londe
- Luann K Labian
- Mary T Lacharite
- Linsay Renae Lacombe
- Lyndsay Lacourse
- Terri Ann Lacroix-Kelty
- Dana M Lacross
All providers in Traverse City, MI · Clinical Medical Laboratory in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2021. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.