Active NPI
Spectra Laboratories Inc
- Clinical Medical Laboratory
- Southaven, MS
National Provider Identifier
1396321022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- SPECTRA LABORATORIES INC
- Practice address
- 1280 Stateline Rd E
Southaven, MS 38671-9486 - Phone
- (877) 334-0021
- Fax
- (800) 716-5539
- NPI assigned
- Mar 23, 2021
- Last updated
- Jun 25, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Alex Ryder, MD
- Title
- Senior VP and Medical Director
- Phone
- (877) 334-0021
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | NU | Primary |
Addresses
Primary practice location
1280 Stateline Rd E
Southaven, MS 38671-9486
Mailing address
1280 Stateline Rd E
Southaven, MS 38671-9486
Phone (877) 334-0021
Other identifiers 39
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396321022 | Medicaid | CT | |
| 4092925 | Medicaid | UT | |
| 112006800 | Medicaid | FL | |
| 649049-OC | Medicaid | AS | |
| 6709267 | Medicaid | VT | |
| 97820288 | Medicaid | NM | |
| L00865 | Medicaid | SC | |
| 08652003 | Medicaid | MS | |
| 100245690C | Medicaid | KS | |
| 2203364 | Medicaid | WA | |
| 7100777440 | Medicaid | KY | |
| Q069018 | Medicaid | TN | |
| 0468700 | Medicaid | OH | |
| 1396321022 | Medicaid | SD | |
| 1396321022 | Medicaid | AK | |
| 1396321022 | Medicaid | ID | |
| 1396321022 | Medicaid | ME | |
| 103860 | Medicaid | AZ | |
| 003263868A | Medicaid | GA | |
| 013403892 | Medicaid | DC | |
| 1396321022 | Medicaid | AL | |
| 1396321022 | Medicaid | MI | |
| 1396321022 | Medicaid | IL | |
| 1396321022 | Medicaid | WV | |
| 2574035 | Medicaid | LA | |
| 700104418 | Medicaid | MO | |
| 9000198819 | Medicaid | CO | |
| 1396321022 | Medicaid | WI | |
| 1396321022 | Medicaid | HI | |
| 1396321022 | Medicaid | MT | |
| 1396321022 | Medicaid | IA | |
| 1396321022 | Medicaid | MN | |
| 273863709 | Medicaid | AR | |
| 10026890900 | Medicaid | NE | |
| 1396321022 | Medicaid | NC | |
| 1396321022 | Medicaid | CA | |
| 209158500 | Medicaid | WY | |
| 440392501 | Medicaid | TX | |
| GBB | Medicaid | GU |
National Provider Directory
National Provider DirectoryMember organizations 1
Organizations listed as members of this organization in the National Provider Directory.
-
dba Shiel Medical Laboratory
- Clinical Medical Laboratory
- Brooklyn, NY
- NPI 1588093165
Member Of
Locations
525 Sycamore Dr
Milpitas, CA 95035
Phone (408) 526-3200
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.
-
- Clinical Pathology/Laboratory Medicine Physician
- Southaven, MS
- NPI 1033435706
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
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"created_epoch": "1616457600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1750809600000",
"number": "1396321022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1280 STATELINE RD E",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386719486",
"telephone_number": "877-334-0021",
"fax_number": "800-716-5539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
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"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386719486",
"telephone_number": "877-334-0021",
"fax_number": "800-716-5539"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SPECTRA LABORATORIES INC",
"organizational_subpart": "NO",
"enumeration_date": "2021-03-23",
"last_updated": "2025-06-25",
"certification_date": "2025-06-25",
"status": "A",
"authorized_official_last_name": "RYDER",
"authorized_official_first_name": "ALEX",
"authorized_official_title_or_position": "SENIOR VP AND MEDICAL DIRECTOR",
"authorized_official_telephone_number": "877-334-0021",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
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],
"endpoints": [],
"other_names": []
}Other providers in Southaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.