NPIMap

Organization Active NPI

Bear Tooth Laboratory, LLC

  • Clinical Medical Laboratory
  • Meridian, ID
National Provider Identifier
1457722092
Registry record updated Oct 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
P1825 Issued in ID
Legal business name
BEAR TOOTH LABORATORY, LLC
Practice address
1125 E Pine Ave
Ste B
Meridian, ID 83642-5955
Phone
(801) 350-1716
NPI assigned
Oct 8, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2015

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

Authorized official

Name
Jason Douglas Coombs, MPC
Title
Owner
Phone
(801) 350-1716

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X P1825 ID Primary

Addresses

Primary practice location

1125 E Pine Ave
Ste B
Meridian, ID 83642-5955

Mailing address

1125 E Pine Ave
Ste B
Meridian, ID 83642-5955
Phone (801) 350-1716

National Provider Directory

National Provider Directory
Tax ID family
Bear Tooth 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

1125 E Pine Ave
Ste B
Meridian, ID 83642
Phone (801) 350-1716

NPI Registry JSON

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

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444262400000",
    "number": "1457722092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 E PINE AVE",
            "address_2": "STE B",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425955",
            "telephone_number": "801-350-1716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 E PINE AVE",
            "address_2": "STE B",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425955",
            "telephone_number": "801-350-1716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAR TOOTH LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-08",
        "last_updated": "2015-10-08",
        "status": "A",
        "authorized_official_last_name": "COOMBS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-350-1716",
        "authorized_official_credential": "MPC"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ID",
            "license": "P1825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.