Medical Instrumentation Corp

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

14D0413340 Issued in IL

Legal business name

MEDICAL INSTRUMENTATION CORP

Practice address

1640 Elk Blvd
Des Plaines, IL 60016-4722

Phone

(847) 954-1134

Fax

(847) 954-1136

NPI assigned

Mar 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Larry Brace, PHD

Title

Director

Phone

(847) 954-1134

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• COAGULATION CONSULTANTS LAB Doing business as

Locations

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1194854885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 ELK BLVD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164722",
            "telephone_number": "847-954-1134",
            "fax_number": "847-954-1136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 ELK BLVD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164722",
            "telephone_number": "847-954-1134",
            "fax_number": "847-954-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL INSTRUMENTATION CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "BRACE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-954-1134",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "14D0413340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D0413340",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COAGULATION CONSULTANTS LAB",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COAGULATION CONSULTANTS LAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Des Plaines, IL
• Providers in Des Plaines, IL by specialty
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; 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.