Eastridge Medical Laboratory Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EASTRIDGE MEDICAL LABORATORY INC

Practice address

212 South Woodbine Rd
Saint Joseph, MO 64506

Phone

(816) 233-9313

Fax

(816) 233-5043

NPI assigned

Sep 22, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Robert Young

Title

Director

Phone

(816) 233-9313

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236211200000",
    "number": "1154317360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8687",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645088687",
            "telephone_number": "816-233-9313",
            "fax_number": "816-233-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 SOUTH WOODBINE RD",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "64506",
            "telephone_number": "816-233-9313",
            "fax_number": "816-233-5043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTRIDGE MEDICAL LABORATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2009-03-05",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "816-233-9313",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26DO652292",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7059727201",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dva Renal Healthcare Inc
• Barbara Petranella Dyer, MD
• Bradley R Dyer, M.D.
• East Ridge Investments LLC
• East Ridge Investments LLC
• Brent James Eaton, DO
• Kristy Eaton, LPC
• Michael Ray Eaton, PMHNP-BC
• Logan Eck, ATC, LAT
• Gail J Eddins, RDH

• Clinical Medical Laboratory in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Clinical Medical Laboratory in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; 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.