Provider Demographics
NPI:1437312162
Name:WESTERN CLINICAL LABORATORY INC
Entity type:Organization
Organization Name:WESTERN CLINICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-783-5201
Mailing Address - Street 1:408 SUNRISE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-783-5201
Mailing Address - Fax:916-783-5286
Practice Address - Street 1:408 SUNRISE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-783-5201
Practice Address - Fax:916-783-5286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 1739291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ36227ZOtherOLD PROVIDER NUMBER