Medical Laboratory Services Medical Group, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MEDICAL LABORATORY SERVICES MEDICAL GROUP, INC.

Practice address

40663 Murrieta Hot Springs Rd Ste C1
Murrieta, CA 92562-9015

Phone

(951) 834-9020

Fax

(951) 834-9026

NPI assigned

May 17, 2007

Last updated

Nov 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ernest HolburtNPI 1235193814

Title

Ceo

Phone

(951) 834-9020

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Medical Laboratory Services Medical Group, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Wildomar, CA
  • NPI 1063477461

  3173615036

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Medical Laboratory Services Medical Group Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
  • NPI 1427011576

  O20070830000840

  Same enrollment

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

CLIA laboratory certificates

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ernest Holburt, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
  • NPI 1235193814
  NPD Authorized official
• Stephen Dongjin Oh, D.O.

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
  • NPI 1881867695
  NPD
• Mahnaz Shahidi-Asl, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Napa, CA
  • NPI 1801082201
  NPD
• Robert Veve, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
  • NPI 1962466078
  NPD
• Duyet C Vo, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
  • NPI 1265496533
  NPD

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1639386964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2740",
            "city": "FALLBROOK",
            "state": "CA",
            "postal_code": "920882740",
            "telephone_number": "805-250-9233",
            "fax_number": "805-578-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40663 MURRIETA HOT SPRINGS RD STE C1",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925629015",
            "telephone_number": "951-834-9020",
            "fax_number": "951-834-9026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL LABORATORY SERVICES MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-06",
        "status": "A",
        "authorized_official_last_name": "HOLBURT",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-834-9020"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0092911",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G471370",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Briana Borda McVey, FNP
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• Med-Ped I D Incorporated (Total Foot & Ankle Restoration & Preservation)
• Medical Laboratory Services Medical Group Inc
• Haley Medina
• Kateline Medina, LICENSED
• Naomie Medina
• Alexa Marie Medjo, PA-C
• Meerweis Stanisai Dental Corporation

• Clinical Medical Laboratory in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; 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.