NPIMap

Organization Active NPI

Apg Medical Laboratory

  • Clinical Medical Laboratory
  • O'Fallon, IL
National Provider Identifier
1376938225
Registry record updated Sep 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
14D0960987 Issued in IL
Legal business name
APG MEDICAL LABORATORY
Practice address
916 Talon Dr
Suite 102
O Fallon, IL 62269-1848
Phone
(618) 628-8211
Fax
(618) 628-0883
NPI assigned
Mar 30, 2015
Last updated
Sep 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2015

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

Authorized official

Name
John S Vick, DONPI 1235135617
Title
Owner
Phone
(618) 628-8211

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 14D0960987 IL Primary

Addresses

Primary practice location

916 Talon Dr
Suite 102
O Fallon, IL 62269-1848

Mailing address

916 Talon Dr
Suite 102
O Fallon, IL 62269-1848
Phone (618) 628-8211

Other identifiers 1

IdentifierTypeStateIssuer
14D0960987OtherILCLIA NUMBER FOR LAB

National Provider Directory

National Provider Directory
Tax ID family
Associated Physicians LTD5 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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1427673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442448000000",
    "number": "1376938225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 TALON DR",
            "address_2": "SUITE 102",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691848",
            "telephone_number": "618-628-8211",
            "fax_number": "618-628-0883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 TALON DR",
            "address_2": "SUITE 102",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691848",
            "telephone_number": "618-628-8211",
            "fax_number": "618-628-0883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APG MEDICAL LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-30",
        "last_updated": "2015-09-17",
        "status": "A",
        "authorized_official_last_name": "VICK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-628-8211",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "14D0960987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER FOR LAB",
            "identifier": "14D0960987",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2015; 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.