NPIMap

Organization Active NPI

Medical Genetics Lab

  • Clinical Medical Laboratory
  • Jackson, MS
National Provider Identifier
1316084015
Registry record updated Feb 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MEDICAL GENETICS LAB
Practice address
2500 N State St Dept Cgen
Room R622
Jackson, MS 39216-4500
Phone
(601) 984-1925
Fax
(601) 984-1916
NPI assigned
Jan 31, 2007
Last updated
Feb 27, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
DEPARTMENT OF PREVENTIVE MEDICINEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2008

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

Authorized official

Name
Miss Sara Lynn Stubbs
Title
Supervisor Business Services
Phone
(601) 984-1925

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X MS Primary

Addresses

Primary practice location

2500 N State St Dept Cgen
Room R622
Jackson, MS 39216-4500

Mailing address

2500 N State St Dept Cgen
Room R622
Jackson, MS 39216-4500
Phone (601) 984-1925

Other identifiers 1

IdentifierTypeStateIssuer
00016106MedicaidMS

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2069976Ummc - Infectious Disease Medicine2500 N State St N502, Jackson, MS 39216Certificate of waiverDec 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Univ Med Pavillion62 organizations share this tax ID, including this one
Part of
University Preventive Med

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2500 N State St
Rm R622
Jackson, MS 39216
Phone (601) 984-1925

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1316084015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST DEPT CGEN",
            "address_2": "ROOM R622",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-1925",
            "fax_number": "601-984-1916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST DEPT CGEN",
            "address_2": "ROOM R622",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-1925",
            "fax_number": "601-984-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL GENETICS LAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEPARTMENT OF PREVENTIVE MEDICINE",
        "enumeration_date": "2007-01-31",
        "last_updated": "2008-02-27",
        "status": "A",
        "authorized_official_last_name": "STUBBS",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "SUPERVISOR BUSINESS SERVICES",
        "authorized_official_telephone_number": "601-984-1925",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00016106",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; 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.