NPIMap

Organization Active NPI

Med Ex PLLC

  • Clinical Medical Laboratory
  • Ravenswood, WV
National Provider Identifier
1316350556
Registry record updated Jun 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
1455 Issued in WV
Legal business name
MED EX PLLC
Practice address
705 Washington St
Ravenswood, WV 26164-1729
Phone
(304) 868-6000
Fax
(304) 868-6002
NPI assigned
Jun 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2014

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

Authorized official

Name
Richard Jay Blackburn, DO
Title
Owner
Phone
(304) 868-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 1455 WV Primary

Addresses

Primary practice location

705 Washington St
Ravenswood, WV 26164-1729

Mailing address

705 Washington St
Ravenswood, WV 26164-1729
Phone (800) 824-2543

Other identifiers 1

IdentifierTypeStateIssuer
3810009472MedicaidWV

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401926400000",
    "number": "1316350556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 WASHINGTON ST",
            "city": "RAVENSWOOD",
            "state": "WV",
            "postal_code": "261641729",
            "telephone_number": "800-824-2543",
            "fax_number": "304-485-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 WASHINGTON ST",
            "city": "RAVENSWOOD",
            "state": "WV",
            "postal_code": "261641729",
            "telephone_number": "304-868-6000",
            "fax_number": "304-868-6002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED EX PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-05",
        "last_updated": "2014-06-05",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-868-6000",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WV",
            "license": "1455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810009472",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ravenswood, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; 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.