CCL Labs LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

CCL LABS LLC

Practice address

2700 Tibbets Dr Ste 102
Bedford, TX 76022-6900

Phone

(844) 990-1335

Fax

(855) 631-0414

NPI assigned

May 8, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Ayaz Ahmad, OWNER

Title

President

Phone

(844) 990-1335

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": "1588896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1639791007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3720 E LA SALLE ST STE 104",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850403976",
            "telephone_number": "844-990-1335",
            "fax_number": "855-631-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 TIBBETS DR STE 102",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760226900",
            "telephone_number": "844-990-1335",
            "fax_number": "855-631-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCL LABS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-08",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A",
        "authorized_official_last_name": "AHMAD",
        "authorized_official_first_name": "AYAZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "844-990-1335",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylee Castaneda
• Kristin Cerise Castillo
• Cathal P Grant MD PA
• Jennifer Catuncan, O.D.
• CBJR Realty LLC
• Victoria Adriana Celaya
• Center for Assisted Reproduction
• Center for Assisted Reproduction Laboratory and Surgery Center, Inc
• Center for Assisted Reproduction Laboratory and Surgery Center, Inc.
• Central Bedford Pharmacy, LLC

• Clinical Medical Laboratory in Bedford, TX
• Providers in Bedford, 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 May 8, 2020; 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.