North Causeway Medical Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

800026144 Issued in FL

Legal business name

NORTH CAUSEWAY MEDICAL LABORATORY

Practice address

161 N Causeway
Suite D
New Smyrna Beach, FL 32169-5303

Phone

(386) 957-3815

Fax

(386) 428-6696

NPI assigned

Sep 8, 2011

Last updated

Sep 8, 2011By 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

Dr. Mark A. Kucker, D.O.

Title

Lab Director

Phone

(386) 957-3815

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315440000000",
    "number": "1184905747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 N CAUSEWAY",
            "address_2": "SUITE D",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321695303",
            "telephone_number": "386-957-3815",
            "fax_number": "386-428-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 N CAUSEWAY",
            "address_2": "SUITE D",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321695303",
            "telephone_number": "386-957-3815",
            "fax_number": "386-428-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CAUSEWAY MEDICAL LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-08",
        "last_updated": "2011-09-08",
        "status": "A",
        "authorized_official_last_name": "KUCKER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "LAB DIRECTOR",
        "authorized_official_telephone_number": "386-957-3815",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "800026144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; 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.