NPIMap

Organization Active NPI

Laboratory Corporation of America

  • Clinical Medical Laboratory
  • Riverside, CA
National Provider Identifier
1821368101
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
LABORATORY CORPORATION OF AMERICA
Practice address
2111 Iowa Ave Ste G
Riverside, CA 92507-7414
Phone
(951) 222-4592
NPI assigned
Jan 4, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Kimberly Williams
Title
VP
Phone
(800) 222-7566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

2111 Iowa Ave Ste G
Riverside, CA 92507-7414

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
05D0918619OtherCLIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031215000817 CA Part B Supplier - Independent Clinical Laboratory 2668379025 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Riverside, CA; San Leandro, CA
O20040309001422 CA Part B Supplier - Independent Clinical Laboratory 2668379025 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monrovia, CA; Tustin, CA

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

Locations

2111 Iowa Ave
Ste G
Riverside, CA 92507
Phone (336) 436-4110

NPI Registry JSON

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

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1821368101",
    "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": "2111 IOWA AVE STE G",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925077414",
            "telephone_number": "951-222-4592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORY CORPORATION OF AMERICA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-04",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "800-222-7566"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D0918619",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.