Provider Demographics
NPI:1104415710
Name:LABORATORY CORPORATION OF AMERICA
Entity type:Organization
Organization Name:LABORATORY CORPORATION OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:T
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-222-7566
Mailing Address - Street 1:PO BOX 2240
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-2240
Mailing Address - Country:US
Mailing Address - Phone:336-436-5884
Mailing Address - Fax:
Practice Address - Street 1:1111 W FRANK AVE STE 303
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3330
Practice Address - Country:US
Practice Address - Phone:936-639-6491
Practice Address - Fax:936-238-7943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D2209169OtherCLIA