=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710221932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABCORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2012
-----------------------------------------------------
Last Update Date | 11/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 SUMMIT VIEW DR
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-4645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-377-7173
-----------------------------------------------------
Fax | 615-263-0412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 SUMMIT VIEW DR
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-4645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-377-7173
-----------------------------------------------------
Fax | 615-263-0412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TECHNICAL DIRECTOR
-----------------------------------------------------
Name | DR. XIAO-XIANG ZHANG
-----------------------------------------------------
Credential | PH.D
-----------------------------------------------------
Telephone | 615-377-7173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | DRM00000026
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | ZHANX1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | ML0000022067
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------