Healthcare Provider Details

I. General information

NPI: 1679787980
Provider Name (Legal Business Name): CLINICAL LABORATORY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ISLAND MEDICAL CENTER SUITE 6
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

PO BOX 5226
CHRISTIANSTED VI
00823-5226
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-5369
  • Fax: 340-778-8573
Mailing address:
  • Phone: 340-778-5369
  • Fax: 340-778-8573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number48D0699866
License Number StateNY

VIII. Authorized Official

Name: SEAN COURSEY
Title or Position: VICE PRESIDENT
Credential:
Phone: 340-778-5369