Healthcare Provider Details

I. General information

NPI: 1033285044
Provider Name (Legal Business Name): TRICORE REFERENCE LABORATORIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WOODWARD PL NE
ALBUQUERQUE NM
87102-2705
US

IV. Provider business mailing address

1001 WOODWARD PL NE ATTENTION: BUSINESS OFFICE
ALBUQUERQUE NM
87102-2705
US

V. Phone/Fax

Practice location:
  • Phone: 505-938-8888
  • Fax: 505-938-8833
Mailing address:
  • Phone: 505-938-8888
  • Fax: 505-938-8833

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: DR. MICHAEL CROSSEY
Title or Position: CEO
Credential: MD
Phone: 505-938-8888