Physicians Reference Laboratory, Inc.

Key facts

NPI

1295848208

Entity type

Organization (NPI type 2)

Primary specialty

Clinical Medical Laboratory 291U00000X

License

0000004059 (TN)

Legal business name

PHYSICIANS REFERENCE LABORATORY, INC.

Practice address

243 Signal Mountain Rd
Suite G
Chattanooga, TN 37405-1933

Phone

(423) 266-1222

Fax

(423) 266-1271

NPI assigned

Aug 16, 2006

Organization subpart

No

Authorized official

Name

Mr. Charles Gorham Rollins, M.T.

Title

Lab Manger

Phone

(423) 886-1212

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• PHYSICIANS REFERENCE LABORATORY, INC Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 1, 2008.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1295848208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 SIGNAL MOUNTAIN RD",
            "address_2": "SUITE G",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374051933",
            "telephone_number": "423-266-1222",
            "fax_number": "423-266-1271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 SIGNAL MOUNTAIN RD",
            "address_2": "SUITE G",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374051933",
            "telephone_number": "423-266-1222",
            "fax_number": "423-266-1271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS REFERENCE LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "ROLLINS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "GORHAM",
        "authorized_official_title_or_position": "LAB MANGER",
        "authorized_official_telephone_number": "423-886-1212",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.T."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TN",
            "license": "0000004059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNESSE STATE LICIENSE",
            "identifier": "4059",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICIANS REFERENCE LABORATORY, INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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