MEDICARE: COMPUNET CLINICAL LABORATORIES LLC

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

General Provider Information

NPI Number	:	1609426907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPUNET CLINICAL LABORATORIES LLC

Provider Business Mailing Address
First Line	:	2308 SANDRIDGE DR
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1856
Country	:	US
Telephone Number	:	937-297-8253
Fax Number	:

Provider Business Practice Location Address
First Line	:	4940 COTTONVILLE RD
Second Line	:
City	:	JAMESTOWN
State	:	OH
Zip	:	45335-1522
Country	:	US
Telephone Number	:	937-374-5360
Fax Number	:	937-374-5365

Authorized Official
Title or Position	:	REVENUE CYCLE DIRECTOR
Name	:	CINDY SMOTHERMAN
Credential	:
Telephone Number	:	513-307-0748

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	01/09/2026

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