Certus Laboratories, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

CERTUS LABORATORIES, LLC

Practice address

3827 Bienville Blvd
Suite 10
Ocean Springs, MS 39564-5868

Phone

(228) 818-0366

Fax

(228) 818-0367

NPI assigned

May 20, 2014

Organization subpart

No

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

Authorized official

Name

Justin Blackwell

Title

Managing Member

Phone

(601) 842-0274

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421020800000",
    "number": "1295147684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3827 BIENVILLE BLVD",
            "address_2": "SUITE 10",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395645868",
            "telephone_number": "228-818-0366",
            "fax_number": "228-818-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3827 BIENVILLE BLVD",
            "address_2": "SUITE 10",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395645868",
            "telephone_number": "228-818-0366",
            "fax_number": "228-818-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CERTUS LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-20",
        "last_updated": "2015-01-12",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "601-842-0274"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nellissa Castillo
• Matthew Ceasar, PHARM.D.
• Tina J Ceccorulli
• Center for Eye Care LTD
• Center for OB-GYN PLLC
• Catrice Cezar
• Karen Champaigne, SLP
• Charles Wayne Chaney
• Abby Chapman
• Anthony Kyle Chapman, DMD

• Clinical Medical Laboratory in Ocean Springs, MS
• Providers in Ocean Springs, MS by specialty
• Clinical Medical Laboratory in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.