Colbert Laboratory Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

09778 Issued in AL

Legal business name

COLBERT LABORATORY INC

Practice address

128 Guard St
Russellville, AL 35653

Phone

(256) 332-6602

Fax

(256) 332-6690

NPI assigned

Sep 1, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Gary L Briles, MLT

Title

Administrator

Phone

(256) 332-6602

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185926400000",
    "number": "1063406320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356530547",
            "telephone_number": "256-332-6602",
            "fax_number": "256-332-6690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 GUARD ST",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "35653",
            "telephone_number": "256-332-6602",
            "fax_number": "256-332-6690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLBERT LABORATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-01",
        "last_updated": "2007-08-01",
        "status": "A",
        "authorized_official_last_name": "BRILES",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "256-332-6602",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MLT"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AL",
            "license": "09778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "57244",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Russellville, AL
• Providers in Russellville, AL by specialty
• Clinical Medical Laboratory in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2007; 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.