Provider Demographics
NPI:1174912695
Name:MADISON CORE LABORATORIES, LLC
Entity type:Organization
Organization Name:MADISON CORE LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-850-0075
Mailing Address - Street 1:PO BOX 1565
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35807-0565
Mailing Address - Country:US
Mailing Address - Phone:256-850-0075
Mailing Address - Fax:256-850-3186
Practice Address - Street 1:2705 ARTIE ST SW
Practice Address - Street 2:BLDG 400 SUITE 25
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805
Practice Address - Country:US
Practice Address - Phone:256-850-0075
Practice Address - Fax:256-850-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 347C00000X
AL01D2097667291U00000X, 291U00000X, 291U00000X
ALL4593291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01D2116823OtherCLIA
1174912695OtherNPI
ALL4593OtherDEPT. OF PUBLIC HEALTH
AL01D2097667OtherCLIA
ALL45100OtherDEPT. OF PUBLIC HEALTH