Advanced Laboratories, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

47D2042960 Issued in VT

Legal business name

ADVANCED LABORATORIES, LLC

Practice address

199 Stratton Rd
Rutland, VT 05701-4890

Phone

(802) 775-7798

Fax

(802) 775-7762

NPI assigned

Jul 24, 2012

Organization subpart

No

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

Authorized official

Name

Mark Logan, MD

Title

Medical Director

Phone

(802) 775-7798

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343088000000",
    "number": "1639425903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 STRATTON RD",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014890",
            "telephone_number": "802-775-7798",
            "fax_number": "802-775-7762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 STRATTON RD",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014890",
            "telephone_number": "802-775-7798",
            "fax_number": "802-775-7762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-24",
        "last_updated": "2012-07-24",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "802-775-7798",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "VT",
            "license": "47D2042960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "47D2042960",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Rutland, VT
• Providers in Rutland, VT by specialty
• Clinical Medical Laboratory in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; 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.