Medical Lab Service

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

PO33 Issued in ID

Legal business name

MEDICAL LAB SERVICE

Practice address

1501 Hiland Ave
Suite J
Burley, ID 83318-2682

Phone

(208) 678-5215

Fax

(208) 678-1472

NPI assigned

Feb 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Wendell L Wells, MD

Title

Director

Phone

(208) 678-8899

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228780800000",
    "number": "1487789343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 HILAND AVE",
            "address_2": "SUITE J",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182682",
            "telephone_number": "208-678-5215",
            "fax_number": "208-678-1472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 HILAND AVE",
            "address_2": "SUITE J",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182682",
            "telephone_number": "208-678-5215",
            "fax_number": "208-678-1472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL LAB SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2008-12-09",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "208-678-8899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ID",
            "license": "PO33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808196400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor McAllister, PA-C
• Ryan Patrick McCormick, P.T., D.P.T.
• Mary Irene McGinnis, LMSW
• Debra Leanor McKnight
• Brent Lee McMillan, P.T.
• Clea K. Mefford, RN MSN CRNP
• Heather M Meyers, PHARMD
• Michael P. Klett, D.O., P.C.
• Dennis J Michaelson, DMD MS
• Bryce Wayne Millar, M.D.

• Clinical Medical Laboratory in Burley, ID
• Providers in Burley, ID by specialty
• Clinical Medical Laboratory in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2008; 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.