Stat Lab, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

15D0360697 Issued in IN

Legal business name

STAT LAB, LLC

Practice address

2201 W Sudbury Ave
Suite a
Bloomington, IN 47403-3737

Phone

(812) 332-8101

Fax

(812) 332-0435

NPI assigned

Oct 25, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Gene P Gebele, MD

Title

Director

Phone

(812) 332-8101

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238716800000",
    "number": "1467442152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 W SUDBURY DR",
            "address_2": "SUITE A",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033737",
            "telephone_number": "812-332-8101",
            "fax_number": "812-332-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 W SUDBURY AVE",
            "address_2": "SUITE A",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033737",
            "telephone_number": "812-332-8101",
            "fax_number": "812-332-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAT LAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-25",
        "last_updated": "2009-04-03",
        "status": "A",
        "authorized_official_last_name": "GEBELE",
        "authorized_official_first_name": "GENE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "812-332-8101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IN",
            "license": "15D0360697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100283160A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "256020",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Clinical Medical Laboratory in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2009; 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.