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General NPI Number Information
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NPI Number | 1437130879
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Entity Type | Organization
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Legal Business Name | NORTH COAST CLINICAL LABORATORY, INC.
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 2215 CLEVELAND RD SUITE 105
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City | SANDUSKY
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State | OH
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Zip | 44870-4485
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Country | US
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Telephone | 419-626-6012
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Fax | 419-626-0814
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Provider Business Mailing Address
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Address Line | 2215 CLEVELAND RD SUITE 105
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City | SANDUSKY
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State | OH
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Zip | 44870-4485
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Country | US
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Telephone | 419-626-6012
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Fax | 419-626-0814
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MR. JACK C. RUNNER
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Credential | MBA, MT(ASCP), SM(AA
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Telephone | 419-626-6012
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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 | N/A
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License Number State |
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