| Name: | Core Diagnostic Laboratories LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Feb 2018 (7 years ago) |
| Entity Number: | 000-508-461 |
| Register Number: | 000508461 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 1930 EDWARDS LAKE ROAD SUITE 138BIRMINGHAM, AL 35235 |
| Registered Office Street Address ZIP Code: | 35235 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598266421 | 2018-02-26 | 2020-12-09 | 211 SUMMIT PKWY STE 124, BIRMINGHAM, AL, 352094742, US | 211 SUMMIT PKWY STE 124, BIRMINGHAM, AL, 352094742, US | |||||||||||||||||||||||||||
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| Phone | +1 205-508-5939 |
| Phone | +1 205-534-5114 |
| Fax | 2052786939 |
Authorized person
| Name | DOUG RANDALL |
| Role | CEO |
| Phone | 2055085939 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | 01D2144684 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 220224 |
| State | AL |
| Name | Role |
|---|---|
| RANDALL, DOUGLAS | Agent |
| Name | Role | Address |
|---|---|---|
| MILLER, MARTHA LEGG | Organizer | 1901 6TH AVENUE NORTH SUITE 1500BIRMINGHAM, AL 35203 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
