Tide Laboratories, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

01D2119386 Issued in AL

Legal business name

TIDE LABORATORIES, LLC

Practice address

913 Airport Rd W Ste B
Fort Payne, AL 35968-3315

Phone

(256) 845-1261

NPI assigned

Apr 8, 2018

Organization subpart

No

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

Authorized official

Name

Trevor Jordan Cleckler

Title

Member

Phone

(256) 516-4153

Specialties & licenses 1

Addresses

Other names 1

• Tide Tox, LLC Former legal business name

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": "1523145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523145600000",
    "number": "1306343231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 AIRPORT RD W STE B",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359683315",
            "telephone_number": "256-845-1261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 AIRPORT RD W STE B",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359683315",
            "telephone_number": "256-845-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDE LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-08",
        "last_updated": "2018-04-08",
        "status": "A",
        "authorized_official_last_name": "CLECKLER",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_middle_name": "JORDAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "256-516-4153"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AL",
            "license": "01D2119386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tide Tox, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Robert W Theakston, M.D.
• Brandi Thomas
• Marisa Andres Thomas
• Thompson Surgical Associates Inc
• Jeffrey Hall Thompson, M.D.
• Total Family Health Care Center, LLC
• Tommy Dewayne Trotman, NP
• Truecare Medical Clinic, LLC
• Valley Head Clinic LLC
• Vision Behavioral Health Services

• Clinical Medical Laboratory in Fort Payne, AL
• Providers in Fort Payne, AL by specialty
• Clinical Medical Laboratory in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2018; 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.