Metrostat Clinical Laboratory-Austin LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

45D2096947 Issued in TX

Legal business name

METROSTAT CLINICAL LABORATORY-AUSTIN LLC

Doing business as

TridentUSA Health Services

Practice address

147 Elmhurst
Suite 300
Kyle, TX 78640-6117

Phone

(512) 922-1151

NPI assigned

Aug 20, 2015

Last updated

Mar 9, 2020By 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

Shawna Fletcher

Title

Provider Relations Coordinator

Phone

(303) 307-2081

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• TridentUSA Health Services Doing business as

Locations

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1235505504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12075 E 45TH AVE",
            "address_2": "SUITE 600",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802393123",
            "telephone_number": "303-371-0073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 ELMHURST",
            "address_2": "SUITE 300",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786406117",
            "telephone_number": "512-922-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METROSTAT CLINICAL LABORATORY-AUSTIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "PROVIDER RELATIONS COORDINATOR",
        "authorized_official_telephone_number": "303-307-2081"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D2096947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "356796701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D2096947",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TridentUSA Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Kyle, TX
• Providers in Kyle, 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 Mar 9, 2020; 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.