=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598421547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLARCS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2021
-----------------------------------------------------
Last Update Date | 12/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 BUTLER DR STE D
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36693-5107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-557-8069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 BUTLER DR STE D
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36693-5107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-557-8069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BRIAN GARREAU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-557-8069
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0105X
-----------------------------------------------------
Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------