North Coast Clinical Laboratory, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

N/A

Legal business name

NORTH COAST CLINICAL LABORATORY, INC.

Practice address

2215 Cleveland Rd
Suite 105
Sandusky, OH 44870-4485

Phone

(419) 626-6012

Fax

(419) 626-0814

NPI assigned

Nov 11, 2005

Last updated

Nov 24, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jack C. Runner, MBA, MT(ASCP), SM(AA

Title

Administrative Director

Phone

(419) 626-6012

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1131667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416787200000",
    "number": "1437130879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 CLEVELAND RD",
            "address_2": "SUITE 105",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704485",
            "telephone_number": "419-626-6012",
            "fax_number": "419-626-0814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 CLEVELAND RD",
            "address_2": "SUITE 105",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704485",
            "telephone_number": "419-626-6012",
            "fax_number": "419-626-0814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH COAST CLINICAL LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-11",
        "last_updated": "2014-11-24",
        "status": "A",
        "authorized_official_last_name": "RUNNER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "419-626-6012",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA, MT(ASCP), SM(AA"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0634273",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36D0344271",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Sandusky, OH
• Providers in Sandusky, OH by specialty
• Clinical Medical Laboratory in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2014; 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.