State of Tennessee

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

0000002293 Issued in TN

Legal business name

STATE OF TENNESSEE

Doing business as

Jackson Regional Laboratory

Practice address

295 Summar Dr
Jackson, TN 38301-3905

Phone

(731) 426-0686

Fax

(731) 421-5199

NPI assigned

Jan 30, 2009

Last updated

Jun 16, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

TENNESSEE DEPARTMENT OF HEALTHAs reported in NPPES

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

Authorized official

Name

Dr. Oristyne E. Walker, PH.D.

Title

Laboratory Director

Phone

(731) 426-0686

Specialties & licenses 1

Addresses

Other names 1

• Jackson Regional Laboratory Doing business as

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

CLIA laboratory certificates

Part of

Loudon County Health de

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Tennessee Department of Health

  dba Stewart County Community Medical Center

  • Public Health or Welfare Agency
  • Dover, TN
  • NPI 1558675728
  NPPES parent name

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245110400000",
    "number": "1396983276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 SUMMAR DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013905",
            "telephone_number": "731-426-0686",
            "fax_number": "731-421-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 SUMMAR DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013905",
            "telephone_number": "731-426-0686",
            "fax_number": "731-421-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TENNESSEE DEPARTMENT OF HEALTH",
        "enumeration_date": "2009-01-30",
        "last_updated": "2009-06-16",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ORISTYNE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "LABORATORY DIRECTOR",
        "authorized_official_telephone_number": "731-426-0686",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TN",
            "license": "0000002293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Regional Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Randall P Staples, D.D.S.
• Star Center, Inc.
• State of Tennessee (West Tennessee Regional Office)
• State of Tennessee (West Tennessee Regional Health Office Communiable Disease Clinic)
• State of Tennessee
• State of Tennessee (West Tennessee Regional Office Dental Clinic)
• Rodney J Staton, DPM
• Julie Stauffer
• Jordan C Steele, MD
• Garret Morgan Steelman, PHARM.D.

• Clinical Medical Laboratory in Jackson, TN
• Providers in Jackson, TN by specialty
• Clinical Medical Laboratory in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.