4 Real Group, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

4 REAL GROUP, LLC

Practice address

613 Worley Glen Ave
Desoto, TX 75115-3321

Phone

(214) 277-9814

Fax

(214) 613-1583

NPI assigned

Apr 5, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eric Tucker

Title

Owner

Phone

(214) 277-9814

Specialties & licenses 2

Addresses

Other names 2

• 4RG Lab Test Doing business as
• Greater Vision Facilities Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1013206630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2587",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750302587",
            "telephone_number": "855-444-7325",
            "fax_number": "214-613-1583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 WORLEY GLEN AVE",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751153321",
            "telephone_number": "214-277-9814",
            "fax_number": "214-613-1583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4 REAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-05",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-277-9814"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "4RG Lab Test",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greater Vision Facilities",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.