Southlake Diagnostics Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SOUTHLAKE DIAGNOSTICS INC

Practice address

580 Commerce St
Suite 150
Southlake, TX 76092-9155

Phone

(817) 421-7414

NPI assigned

May 23, 2014

Last updated

Jul 22, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Don Stables Jr.

Title

Ceo

Phone

(617) 538-1748

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1400803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1053723171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 COMMERCE ST STE 150B",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760929214",
            "telephone_number": "817-421-7414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 COMMERCE ST",
            "address_2": "SUITE 150",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760929155",
            "telephone_number": "817-421-7414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE DIAGNOSTICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-23",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "STABLES",
        "authorized_official_first_name": "DON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "617-538-1748",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southlake Center for Oral and Reconstructive Surgery, PLLC
• Southlake Child and Family Therapy
• Southlake Childrens Sleep Center, LTD
• Southlake Chiropractic Clinic
• Southlake Dental Care, PA
• Southlake Diagnostics Inc
• Southlake Doctors Express, PA PSC (AFC Urgent Care)
• Southlake Emergicare PLLC
• Southlake Endocrinology, PLLC
• Southlake Ers Acquisition Partners LLC (Complete Care Southlake)

• Clinical Medical Laboratory in Southlake, TX
• Providers in Southlake, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; 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.