Lake Havasu Medical Laboratory,LTD.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LAKE HAVASU MEDICAL LABORATORY,LTD.

Practice address

1951 Mesquite Ave
Lake Havasu City, AZ 86403-5746

Phone

(928) 855-4077

Fax

(928) 855-5470

NPI assigned

Dec 27, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Gwenna J Marquis, CLS(NCA)

Title

President

Phone

(928) 855-4077

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558348151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1951 MESQUITE AVE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035746",
            "telephone_number": "928-855-4077",
            "fax_number": "928-855-5470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1951 MESQUITE AVE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035746",
            "telephone_number": "928-855-4077",
            "fax_number": "928-855-5470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HAVASU MEDICAL LABORATORY,LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARQUIS",
        "authorized_official_first_name": "GWENNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-855-4077",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CLS(NCA)"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Clinical Medical Laboratory in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.