NPIMap

Organization Active NPI

Midland Clia

  • Clinical Medical Laboratory
  • Midland, TX
National Provider Identifier
1609183664
Registry record updated Sep 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
CLIA 1123 Issued in TX
Legal business name
MIDLAND CLIA
Practice address
808 W Indiana Ave
Midland, TX 79701-6610
Phone
(432) 570-4475
Fax
(432) 686-3960
NPI assigned
Sep 10, 2010
Last updated
Sep 10, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2010

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

Authorized official

Name
Mr. Michael Earl Waters
Title
Administrator
Phone
(432) 570-4475

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X CLIA 1123 TX Primary

Addresses

Primary practice location

808 W Indiana Ave
Midland, TX 79701-6610

Mailing address

808 W Indiana Ave
Midland, TX 79701-6610
Phone (432) 570-4475

Other identifiers 1

IdentifierTypeStateIssuer
CL1123OtherTXCLIA

National Provider Directory

National Provider Directory
Tax ID family
Inhome Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1284076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284076800000",
    "number": "1609183664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 W INDIANA AVE",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797016610",
            "telephone_number": "432-570-4475",
            "fax_number": "432-686-3960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 W INDIANA AVE",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797016610",
            "telephone_number": "432-570-4475",
            "fax_number": "432-686-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLAND CLIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-10",
        "last_updated": "2010-09-10",
        "status": "A",
        "authorized_official_last_name": "WATERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "432-570-4475",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "CLIA 1123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "CL1123",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; 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.