NPIMap

Organization Active NPI

Nsu-Covenant Village Laboratory

  • Clinical Medical Laboratory
  • Plantation, FL
National Provider Identifier
1477958247
Registry record updated Oct 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
NSU-COVENANT VILLAGE LABORATORY
Practice address
9241 W Broward Blvd
Plantation, FL 33324-2454
Phone
(954) 262-4343
Fax
(954) 262-2269
NPI assigned
Oct 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2014

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

Authorized official

Name
Jill Wallace-Ross, DO
Title
Lab Medical Director
Phone
(954) 262-4343

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

9241 W Broward Blvd
Plantation, FL 33324-2454

Mailing address

PO Box 290370
Davie, FL 33329-0370
Phone (954) 262-4343

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2093069Nova Southeastern University - Covenant Village9241 W Broward Blvd, Plantation, FL 33324Provider-performed microscopyAug 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
Nova Southeaster Univ38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414022400000",
    "number": "1477958247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290370",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333290370",
            "telephone_number": "954-262-4343",
            "fax_number": "954-262-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9241 W BROWARD BLVD",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242454",
            "telephone_number": "954-262-4343",
            "fax_number": "954-262-2269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NSU-COVENANT VILLAGE LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-23",
        "last_updated": "2014-10-23",
        "status": "A",
        "authorized_official_last_name": "WALLACE-ROSS",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "LAB MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "954-262-4343",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.