=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053298067
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICAL LAB PARTNERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2025
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2761 VISTA PKWY STE E7
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-2737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-769-9992
-----------------------------------------------------
Fax | 844-884-0932
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2761 VISTA PKWY STE E7
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-2737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-769-9992
-----------------------------------------------------
Fax | 844-884-0932
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | GREGORY VAX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-769-9992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------