Healthcare Provider Details

I. General information

NPI: 1629116124
Provider Name (Legal Business Name): UNILAB CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 W CHILDS AVE
MERCED CA
95341-6862
US

IV. Provider business mailing address

1201 S COLLEGEVILLE RD
COLLEGEVILLE PA
19426-2998
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-0658
  • Fax:
Mailing address:
  • Phone: 866-697-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0644027
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ALBERT BOWLES
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-454-6000