Vibra of Southeastern Michigan, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

VIBRA OF SOUTHEASTERN MICHIGAN, LLC

Doing business as

Vibra Health Laboratory

Practice address

1307-A Allen Drive
Troy, MI 48083-4010

Phone

(248) 846-0663

NPI assigned

Apr 1, 2020

Last updated

Apr 1, 2020By 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

Mr. Clint T Fegan

Title

Sec/Treasurer

Phone

(717) 591-5700

Specialties & licenses 1

Addresses

Other names 1

• Vibra Health Laboratory Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Vibra of Southeastern Michigan LLC

  dba Vibra of Southeastern Michigan

  • Long Term Care Hospital
  • Taylor, MI
  • NPI 1508027624

  0547339996

  Same PAC ID

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

CLIA laboratory certificates

Tax ID family

Vibra of Southeastern LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Vibra of Southeastern Michigan LLC

  dba Vibra of Southeastern Michigan

  • Long Term Care Hospital
  • Taylor, MI
  • NPI 1508027624
  NPD tax ID
• Vibra of Southeastern Michigan, LLC

  dba Vibra Hospital of Southeastern Michigan - DMC Campus

  • Long Term Care Hospital
  • Detroit, MI
  • NPI 1447617915
  NPD tax ID

Locations

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

{
    "created_epoch": "1585699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585699200000",
    "number": "1134757339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307-A ALLEN DRIVE",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480834010",
            "telephone_number": "248-846-0663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307-A ALLEN DRIVE",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480834010",
            "telephone_number": "248-846-0663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRA OF SOUTHEASTERN MICHIGAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-01",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A",
        "authorized_official_last_name": "FEGAN",
        "authorized_official_first_name": "CLINT",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SEC/TREASURER",
        "authorized_official_telephone_number": "717-591-5700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vibra Health Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lana Vescio
• Mark Vest
• Veteran Medical Equipment and Supplies Inc.
• Vetted
• Vetted LLC (VETTED Veteran Care)
• Kristine Vichinsky
• Natalie Vidana
• Marius G Vidinas, M.D.
• Judy Ann Vieux, LMSW-CLINICAL
• Michelle Berciles Villareal, FNP

• Clinical Medical Laboratory in Troy, MI
• Providers in Troy, MI by specialty
• Clinical Medical Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2020; 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.