Provider Demographics
NPI:1902557119
Name:PENINSULA CLINICAL LABORATORY
Entity Type:Organization
Organization Name:PENINSULA CLINICAL LABORATORY
Other - Org Name:BUTLER'S EMPIRE CLINICAL LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:SHENAE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-244-4333
Mailing Address - Street 1:445 ORIANA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-3742
Mailing Address - Country:US
Mailing Address - Phone:757-291-7272
Mailing Address - Fax:
Practice Address - Street 1:445 ORIANA RD STE 2
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-3742
Practice Address - Country:US
Practice Address - Phone:757-291-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center