Provider Demographics
NPI:1295773380
Name:COMMONWEALTH MEDICAL LABS INC.
Entity type:Organization
Organization Name:COMMONWEALTH MEDICAL LABS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-428-2909
Mailing Address - Street 1:4228 AIKEN DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-3931
Mailing Address - Country:US
Mailing Address - Phone:540-428-2909
Mailing Address - Fax:540-428-2905
Practice Address - Street 1:4228 AIKEN DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20187-3931
Practice Address - Country:US
Practice Address - Phone:540-428-2909
Practice Address - Fax:540-428-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA49D0661031291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0517383Medicaid
ID805782200Medicaid
GA00366099AMedicaid
MS0122009Medicaid
IN100027530AMedicaid
690008904OtherRAILROAD MEDICARE
MO706118908Medicaid
VA465710OtherANTHEM BLUE CROSS BLUE SH
NC7001088Medicaid
AL009801680Medicaid
AR114211709Medicaid
VA35460OtherSOUTHERN HEALTH SVCS
TX0724056-02Medicaid
LA1537527Medicaid
KY37901907Medicaid
VA004980832Medicaid
OH0899167Medicaid
MT0000420359Medicaid
AL923-19860OtherBLUE CROSS BLUE SHIELD
KY37901907Medicaid