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General NPI Number Information
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NPI Number | 1033285044
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Entity Type | Organization
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Legal Business Name | TRICORE REFERENCE LABORATORIES
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 1001 WOODWARD PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2705
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Country | US
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Telephone | 505-938-8888
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Fax | 505-938-8833
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Provider Business Mailing Address
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Address Line | 1001 WOODWARD PL NE ATTENTION: BUSINESS OFFICE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2705
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Country | US
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Telephone | 505-938-8888
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Fax | 505-938-8833
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL CROSSEY
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Credential | MD
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Telephone | 505-938-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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