Organization
COLLABORATIVE LABORATORY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE LAWRENCE (SECRETARY)
(615) 920-7000
Entity
Organization
Contact information
Practice address
1005 PENNSYLVANIA AVE, SUITE 102, OTTUMWA, IA 52501-6413
(641) 684-4621
(641) 682-8976
Mailing address
1005 PENNSYLVANIA AVE, SUITE 102, OTTUMWA, IA 52501-6408
(641) 684-4621
(641) 682-8976
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
16D0387097
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0186841
—
IA
01
—
1023119120
RENDERING PROVIDER
IA
Enumeration date
09/29/2006
Last updated
06/17/2024
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