Prism Molecular LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PRISM MOLECULAR LLC

Practice address

1801 Main St Ste 104
Blakely, PA 18447-1365

Phone

(570) 382-8125

NPI assigned

Feb 6, 2023

Organization subpart

No

Name

Mr. Howard M Wegman

Title

President

Phone

(314) 952-2370

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 1, 2024.

{
    "created_epoch": "1675641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1558067199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 ENCHANTED PKWY STE 202",
            "city": "MANCHESTER",
            "state": "MO",
            "postal_code": "630215491",
            "telephone_number": "314-952-3261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 MAIN ST STE 104",
            "city": "BLAKELY",
            "state": "PA",
            "postal_code": "184471365",
            "telephone_number": "570-382-8125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISM MOLECULAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-06",
        "last_updated": "2024-04-01",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "WEGMAN",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-952-2370",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Lin Noone, LSW
• Open Door Professional Counseling, LLC
• Alan Pace, D.M.D.
• Mary Ellen Pichiarello
• Allison E Popiel, LSW
• Katherine Purswell, PH.D, LPC
• Heather Michelle Rakestraw, PH.D.
• Marie T. Ratchford-Demkosky, MS, RD, LDN,CDE
• Silke H Reddington, DPT
• Casey Reid

• All providers in Blakely, PA
• Clinical Medical Laboratory in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; 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.