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	207SG0203X	Clinical Molecular Genetics Physician
2	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D0674994	OTHER	TX	CLIA

General Provider Information

NPI Number	:	1508843673
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	:	336-436-1048

Provider Business Practice Location Address
First Line	:	7207 GESSNER RD STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-3143
Country	:	US
Telephone Number	:	713-561-4754
Fax Number	:

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	01/14/2019

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Directions to “LABORATORY CORPORATION OF AMERICA ” Practice Location

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