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	36D0350049	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	690002971	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0654619	OTHER	OH	AETNA
2	000000013050	OTHER	OH	ANTHEM BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619972254
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	:	45439-1847
Country	:	US
Telephone Number	:	937-296-0844
Fax Number	:	937-297-8232

Provider Business Practice Location Address
First Line	:	2308 SANDRIDGE DR
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1847
Country	:	US
Telephone Number	:	937-296-0844
Fax Number	:	937-297-8232

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERESA M WILLIAMS
Credential	:
Telephone Number	:	937-297-8228

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	01/09/2026

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Directions to “COMPUNET CLINICAL LABORATORIES LLC ” Practice Location

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