Unique Medi Tech, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

UNIQUE MEDI TECH, LLC

Practice address

20505 Crescent Bay Dr
Lake Forest, CA 92630-8825

Phone

(949) 317-0345

Fax

(949) 446-9141

NPI assigned

Oct 6, 2022

Organization subpart

No

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

Authorized official

Name

Ryan Hilton

Title

Owner

Phone

(305) 332-0669

Specialties & licenses 1

Addresses

Other names 1

• Mammoth Dx Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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

{
    "created_epoch": "1665014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1558086108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20505 CRESCENT BAY DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926308825",
            "telephone_number": "949-317-0345",
            "fax_number": "949-446-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20505 CRESCENT BAY DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926308825",
            "telephone_number": "949-317-0345",
            "fax_number": "949-446-9141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIQUE MEDI TECH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-06",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "HILTON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-332-0669"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mammoth Dx",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mammoth Dx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; 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.