Centennial State Lab, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

CENTENNIAL STATE LAB, LLC

Practice address

4775 Centennial Blvd Ste 120
Colorado Springs, CO 80919-3309

Phone

(719) 284-3522

NPI assigned

Sep 10, 2019

Organization subpart

No

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

Authorized official

Name

Stephanie Brown

Title

Owner

Phone

(719) 284-3522

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1649829987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15351",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011155351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4775 CENTENNIAL BLVD STE 120",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809193309",
            "telephone_number": "719-284-3522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL STATE LAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-10",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-284-3522"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "872314",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Gillis Celenza, OTR/L
• Mailin Sue Celestine, NP-C
• Paige Cenicola
• Centennial Community Care, LLC
• Centennial Medical Group Co LLC
• Bianca Centeno, RBT
• Jonathan Centeno
• Maranda L Centeno, MSOT
• Center at Centennial, LLC
• Center at Centennial, LLC

• Clinical Medical Laboratory in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Clinical Medical Laboratory in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.