Archer Clinic Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

200111 Issued in KY

Legal business name

ARCHER CLINIC LABORATORY

Practice address

400 University Dr
Suite 105
Prestonsburg, KY 41653-1080

Phone

(606) 886-6302

Fax

(606) 886-0597

NPI assigned

Aug 4, 2005

Organization subpart

No

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

Authorized official

Name

Noel Marie Gilliam

Title

Laboratory Manager

Phone

(606) 886-6302

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1123113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199059200000",
    "number": "1295736841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 UNIVERSITY DR",
            "address_2": "SUITE 105",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416531080",
            "telephone_number": "606-886-6302",
            "fax_number": "606-886-0597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 UNIVERSITY DR",
            "address_2": "SUITE 105",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416531080",
            "telephone_number": "606-886-6302",
            "fax_number": "606-886-0597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARCHER CLINIC LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-04",
        "last_updated": "2007-12-31",
        "status": "A",
        "authorized_official_last_name": "GILLIAM",
        "authorized_official_first_name": "NOEL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "LABORATORY MANAGER",
        "authorized_official_telephone_number": "606-886-6302"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "KY",
            "license": "200111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37901055",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Prestonsburg, KY
• Clinical Medical Laboratory in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2007; 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.