Healthcare Provider Details

I. General information

NPI: 1760469076
Provider Name (Legal Business Name): GARCIA CLINICAL LABORATORY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 SPRING ARBOR RD
JACKSON MI
49203-2797
US

IV. Provider business mailing address

2195 SPRING ARBOR RD
JACKSON MI
49203-2797
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-9200
  • Fax: 517-787-1249
Mailing address:
  • Phone: 517-787-9200
  • Fax: 517-787-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. MARY GARCIA
Title or Position: PRESIDENT
Credential:
Phone: 517-787-9200