NPIMap

Organization Active NPI

Community Pathology Laboratory LLC

  • Specialist
  • Cookeville, TN
National Provider Identifier
1366440570
Registry record updated Jan 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
1965 Issued in TN
Legal business name
COMMUNITY PATHOLOGY LABORATORY LLC
Practice address
115 N Peachtree Ave
Cookeville, TN 38501-2546
Phone
(931) 528-2836
Fax
(931) 520-8650
NPI assigned
Jul 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2008

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

Authorized official

Name
Mr. Michael Thomas Hall
Title
Office MGR
Phone
(931) 528-2836

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 1965 TN Primary

Addresses

Primary practice location

115 N Peachtree Ave
Cookeville, TN 38501-2546

Mailing address

115 N Peachtree Ave
Cookeville, TN 38501-2546
Phone (931) 528-2836

Other names 1

  • Cookeville Pathology Lab Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000598 TN Part B Supplier - Clinic/Group Practice 7416860242 Receives reassigned benefits from 6 practitioners
Practice locations: Cookeville, TN

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0316108Community Pathology Laboratory115 N Peachtree Ave, Cookeville, TN 38501AccreditationFeb 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Community Pathology Laboratory LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

115 N Peachtree Ave
Cookeville, TN 38501
Phone (931) 528-2836

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200441600000",
    "number": "1366440570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 N PEACHTREE AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012546",
            "telephone_number": "931-528-2836",
            "fax_number": "931-520-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N PEACHTREE AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012546",
            "telephone_number": "931-528-2836",
            "fax_number": "931-520-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY PATHOLOGY LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2008-01-16",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OFFICE MGR",
        "authorized_official_telephone_number": "931-528-2836",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "1965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cookeville Pathology Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; 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.