Space City Laboratories

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SPACE CITY LABORATORIES

Practice address

12440 Emily CT Ste 301
Sugar Land, TX 77478-4539

Phone

(713) 900-2690

Fax

(713) 900-2691

NPI assigned

Nov 10, 2019

Organization subpart

No

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

Authorized official

Name

Mohammad Usman Aijaz

Title

General Partner

Phone

(281) 235-5842

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1573344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1629613922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2045",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774872045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12440 EMILY CT STE 301",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774784539",
            "telephone_number": "713-900-2690",
            "fax_number": "713-900-2691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE CITY LABORATORIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-10",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "AIJAZ",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "USMAN",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "281-235-5842"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kemi R Sowunmi Donahue
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• Spear Business Enterprises LLC (Spear Hospice)
• Spear Home Healthcare, LLC

• Clinical Medical Laboratory in Sugar Land, TX
• Providers in Sugar Land, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.