Pso Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

23D2036829 Issued in MI

Legal business name

PSO LABORATORY LLC

Practice address

2025 S Washington Ave
Suite 202
Lansing, MI 48910-0828

Phone

(517) 575-6487

NPI assigned

Oct 12, 2012

Organization subpart

No

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

Authorized official

Name

Paula Reeves

Title

Owner

Phone

(517) 575-6487

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350000000000",
    "number": "1306198478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "MASON",
            "state": "MI",
            "postal_code": "488540010",
            "telephone_number": "517-676-9788",
            "fax_number": "517-676-3438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 S WASHINGTON AVE",
            "address_2": "SUITE 202",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489100828",
            "telephone_number": "517-575-6487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSO LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-12",
        "last_updated": "2012-10-12",
        "status": "A",
        "authorized_official_last_name": "REEVES",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-575-6487"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MI",
            "license": "23D2036829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "23D2036829",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; 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.