NPIMap

Organization Active NPI

Laboratory Medicine Consultants LTD

  • Anatomic Pathology & Clinical Pathology Physician
  • Las Vegas, NV
National Provider Identifier
1083675169
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
LABORATORY MEDICINE CONSULTANTS LTD
Practice address
7455 W Washington Ave
Suite 301
Las Vegas, NV 89128-4337
Phone
(702) 732-3441
Fax
(702) 732-2310
NPI assigned
Mar 29, 2006
Last updated
Mar 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Authorized official

Name
Michael C. Grattendick
Title
Vice President
Phone
(561) 626-5512

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X NU
Dermatopathology (Pathology) Physician 207ZD0900X NU
Hematology (Pathology) Physician 207ZH0000X NU
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU Primary
Pediatric Pathology Physician 207ZP0213X NU

Addresses

Primary practice location

7455 W Washington Ave
Suite 301
Las Vegas, NV 89128-4337

Mailing address

11025 Rca Center Dr
Suite 300
Palm Beach Gardens, FL 33410-4269
Phone (561) 626-5512

Other identifiers 1

IdentifierTypeStateIssuer
200225000MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040618000578 NV Part B Supplier - Clinic/Group Practice 4183617533 Receives reassigned benefits from 40 practitioners
Practice locations: Las Vegas, NV; Mesquite, NV

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

2500 Canyon Rd
Ste D1
Bullhead City, AZ 86442
Phone (602) 698-5800

650 Shadow Ln
Las Vegas, NV 89106

7200 Cathedral Rock Dr
Ste 240
Las Vegas, NV 89128
Phone (702) 933-3999

7455 W Washington Ave
Las Vegas, NV 89128
Phone (702) 425-0978

7455 W Washington Ave
Ste 301
Las Vegas, NV 89128
Phone (702) 732-3441

Networks

  • UT PPO C-SNPPlans: DEVOTED C-SNP CHOICE PREMIUM 003 UT (PPO C-SNP) (H4473-003-000, H4473); DEVOTED C-SNP CHOICE PLUS 007 UT (PPO C-SNP) (H4473-007-000, H4473)

Practitioners & affiliated clinicians

Practitioners 45

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.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1083675169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11025 RCA CENTER DR",
            "address_2": "SUITE 300",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104269",
            "telephone_number": "561-626-5512",
            "fax_number": "561-626-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7455 W WASHINGTON AVE",
            "address_2": "SUITE 301",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891284337",
            "telephone_number": "702-732-3441",
            "fax_number": "702-732-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORY MEDICINE CONSULTANTS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "GRATTENDICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "561-626-5512"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ZP0213X",
            "taxonomy_group": "",
            "desc": "Pathology, Pediatric Pathology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200225000",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.