Organization
NORTH COAST CLINICAL LABORATORY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK C. RUNNER MBA, MT(ASCP), SM(AA (ADMINISTRATIVE DIRECTOR)
(419) 626-6012
Entity
Organization
Contact information
Practice address
2215 CLEVELAND RD, SUITE 105, SANDUSKY, OH 44870-4485
(419) 626-6012
(419) 626-0814
Mailing address
2215 CLEVELAND RD, SUITE 105, SANDUSKY, OH 44870-4485
(419) 626-6012
(419) 626-0814
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
N/A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0634273
—
OH
05
—
36D0344271
—
MI
Enumeration date
11/11/2005
Last updated
11/24/2014
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