MEDICARE: LABORATORY CORPORATION OF AMERICA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50D2095150	OTHER		CLIA

General Provider Information

NPI Number	:	1215315791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORY CORPORATION OF AMERICA

Provider Business Mailing Address
First Line	:	PO BOX 2240
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27216-2240
Country	:	US
Telephone Number	:	800-222-7566
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 S BIRCH ST
Second Line	:
City	:	MCCLEARY
State	:	WA
Zip	:	98557-9522
Country	:	US
Telephone Number	:	360-593-0343
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KIMBERLY WILLIAMS
Credential	:
Telephone Number	:	800-222-7566

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	05/15/2015

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