NPIMap

Organization Active NPI

Medical Genetics Lab

Doing business as University Physicians Practice Group

  • Clinical Medical Laboratory
  • Mountain Home, TN
National Provider Identifier
1023229713
Registry record updated Feb 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
2298 Issued in TN
Legal business name
MEDICAL GENETICS LAB
Doing business as
University Physicians Practice Group
Practice address
Building 178, Maple Ave.
Mountain Home, TN 37684
Phone
(423) 439-7320
Fax
(423) 439-7343
NPI assigned
May 24, 2007
Last updated
Feb 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2019

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

Authorized official

Name
Mr. Russell E Lewis
Title
Executive Director
Phone
(423) 433-6050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 2298 TN Primary

Addresses

Primary practice location

Building 178, Maple Ave.
Mountain Home, TN 37684

Mailing address

PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 433-6039

Other identifiers 1

IdentifierTypeStateIssuer
1235200676OtherLAB GROUP NPI

Other names 1

  • UNIVERSITY PHYSICIANS PRACTICE GROUP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dept of Path Lab-C E B27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550188800000",
    "number": "1023229713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699",
            "telephone_number": "423-433-6039",
            "fax_number": "423-433-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BUILDING 178, MAPLE AVE.",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "37684",
            "telephone_number": "423-439-7320",
            "fax_number": "423-439-7343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL GENETICS LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2019-02-15",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "423-433-6050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TN",
            "license": "2298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAB GROUP NPI",
            "identifier": "1235200676",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UNIVERSITY PHYSICIANS PRACTICE GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UNIVERSITY PHYSICIANS PRACTICE GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; 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.