Sam's Medical Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

1790 Issued in MD

Legal business name

SAM'S MEDICAL LABORATORY LLC

Practice address

19614 Club House Rd
Montgomery Village, MD 20886-3035

Phone

(301) 963-0519

Fax

(301) 963-0513

NPI assigned

Apr 1, 2013

Last updated

Apr 1, 2013By 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

Dr. Kan S Lee, PH.D.NPI 1275881419

Title

Medical Diector

Phone

(301) 828-6854

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Kan S Lee, PH.D.

  • Clinical Medical Laboratory
  • Montgomery Village, MD
  • NPI 1275881419
  Authorized official Same address or phone

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364774400000",
    "number": "1083957773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19614 CLUB HOUSE RD",
            "city": "MONTGOMERY VILLAGE",
            "state": "MD",
            "postal_code": "208863035",
            "telephone_number": "301-963-0519",
            "fax_number": "301-963-0513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19614 CLUB HOUSE RD",
            "city": "MONTGOMERY VILLAGE",
            "state": "MD",
            "postal_code": "208863035",
            "telephone_number": "301-963-0519",
            "fax_number": "301-963-0513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S MEDICAL LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-01",
        "last_updated": "2013-04-01",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "KAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEDICAL DIECTOR",
        "authorized_official_telephone_number": "301-828-6854",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "1790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sylvie Neh Sab Ngwota, GNA
• Allison Virginia Sachs Smith
• Alexandra Salcedo
• Lily Salcedo
• Heather Marie Salvatore, M.S., BCBA
• Sanders H. Berk, M.D. PA
• Sandra's Nursing Services, LLC
• Niruja Santhirasegaram, DDS
• Barton Santos, D.M.D
• Nathaniel Addison Sawyer, LCSW-C

• Clinical Medical Laboratory in Montgomery Village, MD
• Providers in Montgomery Village, MD by specialty
• Clinical Medical Laboratory in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.