MEDICARE: CENTRAL CLINICAL LABS INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z161509	OTHER	AZ	MEDICARE
3	P01308159	OTHER	AZ	MEDICARE RAILROAD PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598106163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL CLINICAL LABS INCORPORATED

Provider Business Mailing Address
First Line	:	3720 E LA SALLE ST STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-3976
Country	:	US
Telephone Number	:	480-990-1335
Fax Number	:	490-990-1337

Provider Business Practice Location Address
First Line	:	3720 E LA SALLE ST STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-3976
Country	:	US
Telephone Number	:	480-990-1335
Fax Number	:	490-990-1337

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. AYAZ AHMAD
Credential	:
Telephone Number	:	630-202-9840

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	05/01/2019

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Directions to “CENTRAL CLINICAL LABS INCORPORATED ” Practice Location

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