Mod Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MOD LAB

Practice address

4600 Greenville Avenue
Suite 240
Dallas, TX 75206-5037

Phone

(615) 874-0410

NPI assigned

Apr 7, 2009

Organization subpart

Yes

Parent organization

PROST DATA INCAs reported in NPPES

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

Authorized official

Name

Dr. Jonathan Oppenheimer

Title

Owner

Phone

(615) 874-0410

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Prost Data Inc Former legal business name

Part of

Jonathan R Oppenheimer

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

{
    "created_epoch": "1239062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239062400000",
    "number": "1194968131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 291209",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372291209",
            "telephone_number": "615-874-0410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 GREENVILLE AVENUE",
            "address_2": "SUITE 240",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752065037",
            "telephone_number": "615-874-0410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOD LAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROST DATA INC",
        "enumeration_date": "2009-04-07",
        "last_updated": "2009-04-07",
        "status": "A",
        "authorized_official_last_name": "OPPENHEIMER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-874-0410",
        "authorized_official_name_prefix": "Dr."
    },
    "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": "45D1036151",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prost Data Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Mobimed DX LLC
• Marjorie Mobley, RPH
• Rachael Luise Feuling Mobley, PT, DPT
• Presley M. Mock, MD
• Mockingbird Capital LLC
• Mode Floss PLLC
• Model Hospice LLC
• Mamatha Modem, M.D
• Modern Enhancement
• Modern Gynecology, PLLC

• Clinical Medical Laboratory in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.