Twin Rivers Medical Laboratory, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

TWIN RIVERS MEDICAL LABORATORY, INC

Practice address

902 W. Broadway
Logansport, IN 46947-2978

Phone

(574) 739-0004

Fax

(574) 739-0105

NPI assigned

Jun 21, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Connie Louellen Bostic, RMT

Title

President

Phone

(574) 739-0004

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Locations

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188172800000",
    "number": "1154326668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 W. BROADWAY",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469472978",
            "telephone_number": "574-739-0004",
            "fax_number": "574-739-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 W. BROADWAY",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469472978",
            "telephone_number": "574-739-0004",
            "fax_number": "574-739-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWIN RIVERS MEDICAL LABORATORY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2007-08-27",
        "status": "A",
        "authorized_official_last_name": "BOSTIC",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "LOUELLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-739-0004",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RMT"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy L. Thomas, N.P.
• John R Thompson, MD
• Rachel Leann Tiefel, DNP, FNP-BC
• Tiongson Ophthalmology Clinic, P.C.
• Atanacio Henson Tiongson, M.D.
• Elizabeth Tyner
• Cheryl Lynn Ulery, COTA
• Jessica Jeanne Ulery, RBT
• Marta L Ulrich, RPH
• United Taxi Car Service LLC

• Clinical Medical Laboratory in Logansport, IN
• Providers in Logansport, IN by specialty
• Clinical Medical Laboratory in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; 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.