Organization
CLINICAL REFERENCE LABORATORY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROLYNN JERNIGAN (MANAGER)
(270) 782-8821
Entity
Organization
Contact information
Practice address
615 CHESTNUT ST, BOWLING GREEN, KY 42101-2200
(270) 782-8821
(270) 842-1820
Mailing address
615 CHESTNUT ST, BOWLING GREEN, KY 42101-2200
(270) 782-8821
(270) 842-1820
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
200160
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000112997
ANTHEM PROVIDER NUMBER
KY
05
—
37901717
—
KY
Enumeration date
08/31/2006
Last updated
09/13/2007
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