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General NPI Number Information
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NPI Number | 1598112427
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Entity Type | Organization
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Legal Business Name | CORE BIOTECH SYSTEMS
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 1325 S KILLIAN DR SUITE 1
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City | LAKE PARK
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State | FL
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Zip | 33403-1965
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Country | US
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Telephone | 561-508-8194
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Fax | 561-847-4466
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Provider Business Mailing Address
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Address Line | 1325 S KILLIAN DR SUITE 1
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City | LAKE PARK
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State | FL
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Zip | 33403-1965
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Country | US
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Telephone | 561-508-8194
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Fax | 561-847-4466
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Authorized Official
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Title or Position | LABORATORY GENERAL SUPERVISOR
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Name | WILLIAM ADAM SHIRLEY
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Credential | MS, MLS (ASCP)
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Telephone | 601-540-6974
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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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