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General NPI Number Information
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NPI Number | 1598266421
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Entity Type | Organization
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Legal Business Name | CORE DIAGNOSTIC LABORATORIES LLC
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 211 SUMMIT PKWY STE 124
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City | BIRMINGHAM
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State | AL
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Zip | 35209-4742
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Country | US
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Telephone | 205-534-5114
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Fax | 205-278-6939
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Provider Business Mailing Address
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Address Line | 211 SUMMIT PKWY STE 124
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City | BIRMINGHAM
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State | AL
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Zip | 35209-4742
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Country | US
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Telephone | 205-508-5939
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DOUG RANDALL
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Credential |
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Telephone | 205-508-5939
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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 | 01D2144684
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License Number State | AL
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