NPIMap

Organization Active NPI

Southwest Skin Laboratory PLLC

  • Clinical Medical Laboratory
  • Gilbert, AZ
National Provider Identifier
1124386966
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
03D2046062 Issued in AZ
Legal business name
SOUTHWEST SKIN LABORATORY PLLC
Practice address
1684 E Boston St
Ste 105
Gilbert, AZ 85295-6219
Phone
(480) 855-0085
Fax
(480) 855-0086
NPI assigned
Apr 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Dr. Matthew Travis Woods, MDNPI 1437276276
Title
Owner
Phone
(480) 855-0085

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 03D2046062 AZ Primary

Addresses

Primary practice location

1684 E Boston St
Ste 105
Gilbert, AZ 85295-6219

Mailing address

1688 E Boston St Ste 101
Gilbert, AZ 85295-6222
Phone (480) 855-0085

Other identifiers 1

IdentifierTypeStateIssuer
757609MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121025000381 AZ Part B Supplier - Independent Clinical Laboratory 8921258062 Practice locations: Gilbert, AZ

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1688 E Boston St
Ste 101
Gilbert, AZ 85295
Phone (480) 855-0085

1684 E Boston St
Ste 105
Gilbert, AZ 85295
Phone (480) 855-0085

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1124386966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1688 E BOSTON ST STE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852956222",
            "telephone_number": "480-855-0085",
            "fax_number": "480-855-0086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1684 E BOSTON ST",
            "address_2": "STE 105",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852956219",
            "telephone_number": "480-855-0085",
            "fax_number": "480-855-0086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST SKIN LABORATORY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-30",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "WOODS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "TRAVIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-855-0085",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "03D2046062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "757609",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.