Imaginus Diagnostic Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

IMAGINUS DIAGNOSTIC LABORATORY LLC

Practice address

17673 US Highway 271
Spiro, OK 74959-5300

Phone

(479) 650-9459

NPI assigned

Mar 13, 2020

Organization subpart

No

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

Authorized official

Name

Brittany White

Title

Managing Member

Phone

(479) 650-9459

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1584057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1417583162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5616 WILLIAMSON PL",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729168415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17673 US HIGHWAY 271",
            "city": "SPIRO",
            "state": "OK",
            "postal_code": "749595300",
            "telephone_number": "479-650-9459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINUS DIAGNOSTIC LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-13",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "479-650-9459"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Spiro, OK
• Providers in Spiro, OK by specialty
• Clinical Medical Laboratory in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; 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.