Mississippi Valley Laboratory, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MISSISSIPPI VALLEY LABORATORY, LLC

Practice address

3400 Dexter CT
Suite 205
Davenport, IA 52807-3461

Phone

(563) 344-6690

Fax

(563) 344-6699

NPI assigned

Apr 27, 2006

Organization subpart

No

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

Authorized official

Name

Jeanne M Farris, MT ASCP

Title

Laboratory Manager

Phone

(563) 344-6692

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639136187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DEXTER CT",
            "address_2": "SUITE 205",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073461",
            "telephone_number": "563-344-6690",
            "fax_number": "563-344-6699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 DEXTER CT",
            "address_2": "SUITE 205",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073461",
            "telephone_number": "563-344-6690",
            "fax_number": "563-344-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI VALLEY LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FARRIS",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "LABORATORY MANAGER",
        "authorized_official_telephone_number": "563-344-6692",
        "authorized_official_credential": "MT ASCP"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0142265",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "54573",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janene Misak, PA-C
• Ashlee Misiag, ARNP
• Mississippi Medical Plaza, LC
• Mississippi Valley Bariatrics
• Mississippi Valley Imaging, LLC
• Mississippi Valley Oral & Maxillofacial Surgery PC
• Mississippi Valley Sleep Disorder Center LC
• Mississippi Valley Sleep Supplies
• Robert Mixsell, MD
• Craig Edward Moe, MD

• Clinical Medical Laboratory in Davenport, IA
• Providers in Davenport, IA by specialty
• Clinical Medical Laboratory in Iowa

• 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.