Healthcare Provider Details

I. General information

NPI: 1003562943
Provider Name (Legal Business Name): CLECORE LAB & SCREENINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 E OVERLOOK RD
CLEVELAND HEIGHTS OH
44118-2143
US

IV. Provider business mailing address

3247 E OVERLOOK RD
CLEVELAND HEIGHTS OH
44118-2143
US

V. Phone/Fax

Practice location:
  • Phone: 216-324-2161
  • Fax:
Mailing address:
  • Phone: 216-324-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291900000X
TaxonomyMilitary Clinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY WILSON
Title or Position: DIRECTOR
Credential: PN161964
Phone: 216-324-2161