MEDICARE: CLECORE LAB & SCREENINGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	291900000X	Military Clinical Medical Laboratory
2	291U00000X	Clinical Medical Laboratory
3	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1003562943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLECORE LAB & SCREENINGS LLC

Provider Business Mailing Address
First Line	:	3247 E OVERLOOK RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2143
Country	:	US
Telephone Number	:	216-324-2161
Fax Number	:

Provider Business Practice Location Address
First Line	:	3247 E OVERLOOK RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2143
Country	:	US
Telephone Number	:	216-324-2161
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KIMBERLY WILSON
Credential	:	PN161964
Telephone Number	:	216-324-2161

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/03/2022

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