Organization Active NPI

Pharmacogenetics Diagnostic Laboratory LLC

Doing business as PGXL Laboratories

Clinical Medical Laboratory
Louisville, KY

National Provider Identifier

1255376620

Registry record updated May 7, 2015

On this page

Key facts
NPPES NPI Registry
Laboratory certificates & supplier records
National Provider Directory
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Louisville, KY
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Clinical Medical LaboratoryTaxonomy code 291U00000X
License: 200251 Issued in KY
Legal business name: PHARMACOGENETICS DIAGNOSTIC LABORATORY LLC
Doing business as: PGXL Laboratories
Practice address: 201 E Jefferson St
Suite 309
Louisville, KY 40202-1246
Phone: (502) 569-1584
Fax: (502) 569-1585
NPI assigned: Jun 18, 2006
Last updated: May 7, 2015By the provider in NPPES
Organization subpart: No

NPPES NPI Registry

Updated by the provider on May 7, 2015

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

Authorized official

Name: Mark Linder, PHDNPI 1255466223
Title: VP
Phone: (502) 569-1584

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Clinical Medical Laboratory	291U00000X	200251	KY	Primary

Addresses

Primary practice location

201 E Jefferson St
Suite 309
Louisville, KY 40202-1246

Mailing address

201 E Jefferson St
Suite 309
Louisville, KY 40202-1246
Phone (502) 569-1584

Other identifiers 34

Identifier	Type	State	Issuer
100262578-00	Medicaid	NE
2338391	Medicaid	LA
TIN-001	Medicaid	IL
1255376620	Medicaid	MT
1255376620	Medicaid	VA
200970280A	Medicaid	KS
4215397 00	Medicaid	MD
000000531561	Other	KY	ANTHEM BLUE CROSS
003132163A	Medicaid	GA
1255376620	Medicaid	AL
3810025173	Medicaid	WV
738908	Medicaid	HI
0380351	Medicaid	NJ
1255376620	Medicaid	ID
1255376620	Medicaid	MO
500652629	Medicaid	OR
00026220	Medicaid	MS
0065657	Medicaid	OH
1582673	Medicaid	AK
2659764	Medicaid	MI
195993709	Medicaid	AR
L00368	Medicaid	SC
0110438	Medicaid	IA
102795040 0001	Medicaid	PA
1255376620	Medicaid	UT
1255376620	Medicaid	WA
1530585	Medicaid	TN
50121715	Medicaid	CO
808295	Medicaid	AZ
06555519	Medicaid	NM
1255376620	Medicaid	ME
201093810A	Medicaid	IN
7001484	Medicaid	NC
7405899	Medicaid	KY

Other names 1

PGXL Laboratories Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
18D2047286	Kentucky Clinical Trials Laboratory201 East Jefferson Street Ste 113, Louisville, KY 40202	Compliance	Jan 6, 2027
18D2282763	Kentucky Clinical Trials Laboratory201 East Jefferson Street, Louisville, KY 40202	Certificate of waiver	May 24, 2027

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Mark W Linder, PHD
- Laboratory Management Specialist/Technologist
- Louisville, KY
- NPI 1255466223
Authorized official Same address or phone

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430956800000",
    "number": "1255376620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E JEFFERSON ST",
            "address_2": "SUITE 309",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021246",
            "telephone_number": "502-569-1584",
            "fax_number": "502-569-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E JEFFERSON ST",
            "address_2": "SUITE 309",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021246",
            "telephone_number": "502-569-1584",
            "fax_number": "502-569-1585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACOGENETICS DIAGNOSTIC LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2015-05-07",
        "status": "A",
        "authorized_official_last_name": "LINDER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "502-569-1584",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "KY",
            "license": "200251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100262578-00",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2338391",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TIN-001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255376620",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255376620",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200970280A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4215397 00",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "000000531561",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003132163A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255376620",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810025173",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "738908",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0380351",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255376620",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255376620",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500652629",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00026220",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0065657",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1582673",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2659764",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195993709",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L00368",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0110438",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102795040 0001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255376620",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255376620",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1530585",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50121715",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808295",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06555519",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255376620",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201093810A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7001484",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7405899",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PGXL Laboratories",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
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.