Brazosport Clinical Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

45D0497096 Issued in TX

Legal business name

BRAZOSPORT CLINICAL LAB

Practice address

54 Flag Lake PLZ
Lake Jackson, TX 77566-6263

Phone

(979) 297-0362

Fax

(979) 297-9096

NPI assigned

May 29, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Richard A Hardoin, MD

Title

President

Phone

(979) 297-0362

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1336307172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 FLAG LAKE PLZ",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775666263",
            "telephone_number": "979-297-0362",
            "fax_number": "979-297-9096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 FLAG LAKE PLZ",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775666263",
            "telephone_number": "979-297-0362",
            "fax_number": "979-297-9096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOSPORT CLINICAL LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-29",
        "last_updated": "2008-05-29",
        "status": "A",
        "authorized_official_last_name": "HARDOIN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "979-297-0362",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D0497096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D0497096",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brazoria Neurological Associates, P.a.
• Brazos Eye Care LLC
• Brazos Primary Care Associates
• Brazos River Emergency Physicians PLLC
• Brazosport Cardiology, P.a. (Pearland Heart Institute)
• Brazosport Dermatology Clinic PA
• Brazosport Ear, Nose & Throat Clinic, PA
• Brazosport Eye Facility, Inc. (Brazosport Eye Institute)
• Brazosport Health Alliance
• Brazosport Health Alliance

• Clinical Medical Laboratory in Lake Jackson, TX
• Providers in Lake Jackson, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; 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.