NPIMap

Organization Active NPI

Southern Diagnostic Laboratories, LLC

  • Clinical Medical Laboratory
  • Flowood, MS
National Provider Identifier
1336468784
Registry record updated Oct 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
25D2003695 Issued in MS
Legal business name
SOUTHERN DIAGNOSTIC LABORATORIES, LLC
Practice address
1050 River Oaks Drive
Suite 120
Flowood, MS 39292
Phone
(601) 933-8600
NPI assigned
May 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2013

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

Authorized official

Name
Mr. Steve Boyd
Title
Ceo
Phone
(205) 313-1240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 25D2003695 MS Primary

Addresses

Primary practice location

1050 River Oaks Drive
Suite 120
Flowood, MS 39292

Mailing address

2732 7TH Ave S
Birmingham, AL 35233-3406
Phone (205) 313-1240

Other identifiers 1

IdentifierTypeStateIssuer
07921751MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Southern Diagnostic Laboratories LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1274745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381276800000",
    "number": "1336468784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2732 7TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352333406",
            "telephone_number": "205-313-1240",
            "fax_number": "205-313-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 RIVER OAKS DRIVE",
            "address_2": "SUITE 120",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "39292",
            "telephone_number": "601-933-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DIAGNOSTIC LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-25",
        "last_updated": "2013-10-09",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-313-1240",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MS",
            "license": "25D2003695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07921751",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; 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.