Organization
CENTRAL CLINICAL LABS INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AYAZ AHMAD (PRESIDENT)
(630) 202-9840
Entity
Organization
Contact information
Practice address
3720 E LA SALLE ST STE 103, PHOENIX, AZ 85040-3976
(480) 990-1335
(490) 990-1337
Mailing address
3720 E LA SALLE ST STE 103, PHOENIX, AZ 85040-3976
(480) 990-1335
(490) 990-1337
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
845461
—
AZ
01
—
P01308159
MEDICARE RAILROAD PTAN
AZ
01
—
Z161509
MEDICARE
AZ
Enumeration date
07/11/2013
Last updated
05/01/2019
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