Genomic Testing Cooperative Lca

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GENOMIC TESTING COOPERATIVE LCA

Practice address

25371 Commercentre Dr
Lake Forest, CA 92630-8859

Phone

(949) 540-9421

Fax

(949) 301-9719

NPI assigned

Jan 7, 2019

Last updated

Jun 28, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Lawrence Eck

Title

Coo

Phone

(657) 202-5951

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA, TX2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1546819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1346713989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25371 COMMERCENTRE DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926308859",
            "telephone_number": "657-202-5951",
            "fax_number": "949-301-9719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25371 COMMERCENTRE DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926308859",
            "telephone_number": "949-540-9421",
            "fax_number": "949-301-9719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOMIC TESTING COOPERATIVE LCA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-07",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "ECK",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "657-202-5951",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D2111917",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.