| Name | Value |
|---|---|
| PROVIDER TYPE | Technologists, Technicians & Other Technical Service Providers |
| CLASSIFICATION | Pathology |
| DEFINITION | An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405. |
| AREA OF SPECIALIZATION | Clinical Laboratory Director, Non-physician |
| STATUS | Active |
| VA CODE | V183413 |
| X12 CODE | 247ZC0005X |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255756 |
| EFFECTIVE DATE/TIME |
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