Provider Demographics
NPI:1447658042
Name:MEDLAB TREATMENT CENTER
Entity type:Organization
Organization Name:MEDLAB TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:704-332-3800
Mailing Address - Street 1:2301 W MOREHEAD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5271
Mailing Address - Country:US
Mailing Address - Phone:704-332-3800
Mailing Address - Fax:704-332-3805
Practice Address - Street 1:2301 W MOREHEAD ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-9798
Practice Address - Country:US
Practice Address - Phone:704-332-3800
Practice Address - Fax:704-332-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty