United Clinical Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

UNITED CLINICAL LAB LLC

Practice address

4859 Dover Center Rd Ste 12
North Olmsted, OH 44070-3189

Phone

(440) 455-1444

NPI assigned

May 4, 2022

Last updated

May 20, 2022By 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

Saifidean Ottallah

Title

Ceo/Owner

Phone

(440) 455-1444

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653004800000",
    "number": "1871238709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4859 DOVER CENTER RD STE 12",
            "city": "NORTH OLMSTED",
            "state": "OH",
            "postal_code": "440703189",
            "telephone_number": "440-455-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4859 DOVER CENTER RD STE 12",
            "city": "NORTH OLMSTED",
            "state": "OH",
            "postal_code": "440703189",
            "telephone_number": "440-455-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED CLINICAL LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-04",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A",
        "authorized_official_last_name": "OTTALLAH",
        "authorized_official_first_name": "SAIFIDEAN",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "440-455-1444"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "36D2257969",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; 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.