Envision Health Lab, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

036.100502 Issued in IL

Legal business name

ENVISION HEALTH LAB, LLC

Practice address

1716 Corporate Xing
O Fallon, IL 62269-3743

Phone

(618) 717-8270

Fax

(618) 726-2030

NPI assigned

Jul 5, 2016

Organization subpart

No

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

Authorized official

Name

Vince Ojeda

Title

Ceo

Phone

(618) 717-8270

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1467676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468540800000",
    "number": "1558713313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1716 CORPORATE XING",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693743",
            "telephone_number": "618-717-8270",
            "fax_number": "618-726-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1716 CORPORATE XING",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693743",
            "telephone_number": "618-717-8270",
            "fax_number": "618-726-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISION HEALTH LAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-05",
        "last_updated": "2016-07-15",
        "status": "A",
        "authorized_official_last_name": "OJEDA",
        "authorized_official_first_name": "VINCE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-717-8270"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "036.100502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; 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.