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	14D2257499	OTHER		CLIA

General Provider Information

NPI Number	:	1669104980
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4058 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-4639
Country	:	US
Telephone Number	:	773-432-4033
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KIMBERLY T WILLIAMS
Credential	:
Telephone Number	:	336-436-5761

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	07/07/2022

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Directions to “LABORATORY CORPORATION OF AMERICA ” Practice Location

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