Healthcare Provider Details

I. General information

NPI: 1679566954
Provider Name (Legal Business Name): CLINICAL LABORATORY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 LINCOLN MEDICAL PARK 102 LINCOLN MEDICAL PARK
LINCOLNTON NC
28092-4402
US

IV. Provider business mailing address

1446 E GASTON ST 102 LINCOLN MEDICAL PARK
LINCOLNTON NC
28092-4416
US

V. Phone/Fax

Practice location:
  • Phone: 704-732-1752
  • Fax: 704-736-0273
Mailing address:
  • Phone: 704-732-1752
  • Fax: 704-736-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARGARET ANN HYDER
Title or Position: PRESIDENT
Credential:
Phone: 704-732-1752