Resourceful Clinical Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

RESOURCEFUL CLINICAL LABORATORY LLC

Practice address

5412 Central Ave Ste a
Charlotte, NC 28212-2706

Phone

(704) 503-9961

Fax

(704) 563-3356

NPI assigned

Jan 30, 2019

Organization subpart

No

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

Authorized official

Name

Stephanie Tyson

Title

Managing Member

Phone

(980) 213-5501

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

{
    "created_epoch": "1548806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670976000000",
    "number": "1346704723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5412 CENTRAL AVE STE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282122706",
            "telephone_number": "704-503-9961",
            "fax_number": "704-563-3356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5412 CENTRAL AVE STE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282122706",
            "telephone_number": "704-503-9961",
            "fax_number": "704-563-3356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESOURCEFUL CLINICAL LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-30",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A",
        "authorized_official_last_name": "TYSON",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "980-213-5501"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346704723",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "styson13414@yahoo.com",
            "affiliation": "N",
            "address_1": "5412 Central Ave Ste A",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282122706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Medical Laboratory in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Medical Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.