NPIMap

Organization Active NPI

Medtech LLC

  • Clinical Medical Laboratory
  • Southfield, MI
National Provider Identifier
1053132274
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MEDTECH LLC
Practice address
29777 Telegraph Rd
Southfield, MI 48034-1303
Phone
(313) 425-1520
NPI assigned
Oct 21, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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

Authorized official

Name
Jazlyn Davis, LABORATORY DIRECTORNPI 1598545212
Title
Owner
Phone
(313) 425-1520

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary
Point of Service 305S00000X

Addresses

Primary practice location

29777 Telegraph Rd
Southfield, MI 48034-1303

Mailing address

29777 Telegraph Rd
Southfield, MI 48034-1303

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1729468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1053132274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29777 TELEGRAPH RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29777 TELEGRAPH RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341303",
            "telephone_number": "313-425-1520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDTECH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-21",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAZLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-425-1520",
        "authorized_official_credential": "LABORATORY DIRECTOR"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; 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.