Community Medical Laboratory, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

03D2115501

Legal business name

COMMUNITY MEDICAL LABORATORY, LLC

Doing business as

Community Medical Laboratory

Practice address

1695 Mesquite Ave Ste 202
Lake Havasu City, AZ 86403-5687

Phone

(928) 733-6170

NPI assigned

Aug 6, 2016

Organization subpart

No

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

Authorized official

Name

Julia A Porter

Title

Member

Phone

(928) 733-6170

Specialties & licenses 1

Addresses

Other names 1

• Community Medical Laboratory Doing business as

Tax ID family

Community Medical Laboratoriesllc2 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.

• Community Medical Laboratories,LLC

  • Clinical Medical Laboratory
  • Tempe, AZ
  • NPI 1760887814
  NPD tax ID

Locations

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

{
    "created_epoch": "1470441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470441600000",
    "number": "1457805533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 MESQUITE AVE STE 202",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035687",
            "telephone_number": "928-733-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 MESQUITE AVE STE 202",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035687",
            "telephone_number": "928-733-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-06",
        "last_updated": "2016-08-06",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "JULIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "928-733-6170"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": "03D2115501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Medical Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Richard Ryan Coburn, DMD
• Kimberly Ann Coffey, PHARMD
• Wayne L Cohen, RPH
• Tamra J Coleman, PT
• Colorado River Pain Management LLC
• Community Medical Services Arizona-Private, LLC (Community Medical Services)
• Community Medical Services Arizona-Private, LLC (Community Medical Services Lake Havasu)
• Concierge Health LLC
• Bridget Christine Conley, PA-C
• Rakel Connell, MS

• Clinical Medical Laboratory in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Clinical Medical Laboratory in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2016; 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.