Organization Active NPI

Bostwick Laboratories, Inc.

Clinical Medical Laboratory
Glen Allen, VA

National Provider Identifier

1124051644

Registry record updated Mar 29, 2013

On this page

Key facts
NPPES NPI Registry
National Provider Directory
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Glen Allen, VA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name: BOSTWICK LABORATORIES, INC.
Practice address: 4355 Innslake Dr
Glen Allen, VA 23060-6742
Phone: (804) 967-9225
Fax: (804) 239-1954
NPI assigned: Jul 8, 2006
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Mar 29, 2013

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

Authorized official

Name: Mr. Martin J Stefanelli
Title: Ceo
Phone: (516) 512-5200

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Clinical Medical Laboratory	291U00000X			Primary

Addresses

Primary practice location

4355 Innslake Dr
Glen Allen, VA 23060-6742

Mailing address

PO Box 403751
Atlanta, GA 30384-3751
Phone (804) 967-9225

Other identifiers 41

Identifier	Type	State	Issuer
000000265139	Other	OH	UNISON HEALTH (OH MEDICAID HMO)
036874800	Other	DC	MEDICAID (ACS)
036874800	Medicaid	DC
0421311	Medicaid	MT
1009021320002	Medicaid	PA
120124700	Medicaid	WY
138056	Other	VA	ANTHEM BCBS OF VIRGINIA
164040101	Medicaid	TX
200024720A	Medicaid	OK
32287232	Medicaid	CO
440615	Medicaid	AZ
82083339	Medicaid	NM
01837399	Medicaid	MS
100503849	Medicaid	NV
1198722	Medicaid	LA
32940800	Medicaid	WI
8069026	Medicaid	ID
010062811	Medicaid	VA
0578229	Medicaid	IA
152979709	Medicaid	AR
200375010A	Medicaid	IN
275326 MCD	Medicaid	OR
690000006	Medicaid	AL
164650710	Medicaid	MI
1900009	Medicaid	RI
200262210A	Medicaid	KS
20073351	Other	SC	SC SELECT HEALTH/MEDICAID HMO
2420571	Medicaid	OH
37000718	Medicaid	KY
4582490	Medicaid	TN
568644630A	Medicaid	GA
533631	Other	AZ	MERCY CARE PLAN
7001242	Medicaid	NC
911980900	Medicaid	FL
L00184	Medicaid	SC
409261900	Medicaid	MD
6701112000	Medicaid	WV
419300000	Medicaid	ME
7123995	Medicaid	WA
1124051644	Medicaid	MN
706132305	Medicaid	MO

National Provider Directory

Locations

1700 N Desert Dr
Tempe, AZ 85288
Phone (602) 225-0005

2500 Sand Lake Rd
Orlando, FL 32809
Phone (407) 888-1051

100 Charles Lindbergh Blvd
Uniondale, NY 11553
Phone (516) 512-5200

320 Plus Park Blvd
Nashville, TN 37217
Phone (615) 815-2860

7420 Remcon Cir
#J
El Paso, TX 79912
Phone (804) 967-9225

4355 Innslake Dr
Glen Allen, VA 23060
Phone (804) 288-6564

601 Biotech Dr
North Chesterfield, VA 23235
Phone (804) 648-3820

Networks

Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Practitioners & affiliated clinicians

Practitioners 2

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

David G Bostwick, MD MBA
- Anatomic Pathology Physician
- Orlando, FL
- NPI 1467555987
NPD (past)
Richard K Cochran, MD FCAP
- Anatomic Pathology & Clinical Pathology Physician
- Tempe, AZ
- NPI 1417050568
NPD (past)

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1124051644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 403751",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303843751",
            "telephone_number": "804-967-9225",
            "fax_number": "804-239-1954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4355 INNSLAKE DR",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606742",
            "telephone_number": "804-967-9225",
            "fax_number": "804-239-1954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTWICK LABORATORIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2013-03-29",
        "status": "A",
        "authorized_official_last_name": "STEFANELLI",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "516-512-5200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
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        {
            "code": "01",
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        {
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        {
            "code": "05",
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            "issuer": null,
            "identifier": "706132305",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; 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.