MEDICARE: CONSULTATION LABORATORY INC

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	51533252	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1871533174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSULTATION LABORATORY INC

Provider Business Mailing Address
First Line	:	1600 CARRAWAY BLVD
Second Line	:	SUITE 460
City	:	BIRMINGHAM
State	:	AL
Zip	:	35234
Country	:	US
Telephone Number	:	205-502-6600
Fax Number	:	205-502-6604

Provider Business Practice Location Address
First Line	:	1600 CARRAWAY BLVD
Second Line	:	SUITE 460
City	:	BIRMINGHAM
State	:	AL
Zip	:	35234-1913
Country	:	US
Telephone Number	:	205-502-6600
Fax Number	:	205-502-6604

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RALPH JOE TEAGUE
Credential	:	M.D.
Telephone Number	:	205-502-6600

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/22/2020

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Directions to “CONSULTATION LABORATORY INC ” Practice Location

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