Burrell Mobile Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

19D2055006 Issued in LA

Legal business name

BURRELL MOBILE LAB

Practice address

2101 Tower Dr
Monroe, LA 71201-5045

Phone

(504) 210-6317

NPI assigned

Mar 26, 2013

Organization subpart

No

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

Authorized official

Name

Jeremy Burrell

Title

Owner

Phone

(504) 210-6317

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364256000000",
    "number": "1346582400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S 6TH ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712022228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 TOWER DR",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015045",
            "telephone_number": "504-210-6317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURRELL MOBILE LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-26",
        "last_updated": "2013-03-26",
        "status": "A",
        "authorized_official_last_name": "BURRELL",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-210-6317"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "LA",
            "license": "19D2055006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19D2055006",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Myrtle Burks
• Tondra Burks
• Tom William Burnett I, LAC
• Emily Lyle Burns, BCBA/LBA
• Jordan Moriah Burns
• Jeremy Burrell
• Camryn Burroughs
• De'Michael Bursey
• Larry Bursey
• Terri Lynne Bursey, LPC

• Clinical Medical Laboratory in Monroe, LA
• Providers in Monroe, LA by specialty
• Clinical Medical Laboratory in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.