PGN Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PGN LAB LLC

Practice address

7847 SW Ellipse Way
Stuart, FL 34997-7247

Phone

(561) 818-8054

NPI assigned

Nov 1, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Cory Brandon Hanlon

Title

Owner

Phone

(561) 818-8054

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

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

{
    "created_epoch": "1509494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509494400000",
    "number": "1457863391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4365 HICKORY DR",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334183905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7847 SW ELLIPSE WAY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349977247",
            "telephone_number": "561-818-8054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PGN LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-01",
        "last_updated": "2017-11-01",
        "status": "A",
        "authorized_official_last_name": "HANLON",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "BRANDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-818-8054",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Petrik
• Cheyenne Petrillo, DC
• Fernando Petry, D.O.
• Katherine Pettigrew
• Eric Alexander Pfeiffer, M. D.
• Jennifer Lynn Pham
• Tuong Van Thi Pham, PHARMD
• Sadie Phelan
• Maya F Phelps
• Patrick Phelps

• Clinical Medical Laboratory in Stuart, FL
• Providers in Stuart, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.