NPIMap

Organization Active NPI

RM Lab LLC

Doing business as Express Lab

  • Clinical Medical Laboratory
  • Idaho Falls, ID
National Provider Identifier
1659301349
Registry record updated Oct 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
13D0520868 Issued in ID
Legal business name
RM LAB LLC
Doing business as
Express Lab
Practice address
2220 E 25TH St
Idaho Falls, ID 83404-7542
Phone
(208) 529-8330
Fax
(208) 523-3318
NPI assigned
Jul 5, 2006
Last updated
Oct 2, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2014

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

Authorized official

Name
Von Crofts
Title
Ceo
Phone
(208) 523-1122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 13D0520868 ID Primary

Addresses

Primary practice location

2220 E 25TH St
Idaho Falls, ID 83404-7542

Mailing address

3910 Washington Pkwy
Idaho Falls, ID 83404-7596
Phone (208) 529-8330

Other identifiers 1

IdentifierTypeStateIssuer
806230600MedicaidID

Other names 1

  • Express Lab Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150106002168 ID Part B Supplier - Independent Clinical Laboratory 4082937636 Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Locations

3910 Washington Pkwy
Ste B
Idaho Falls, ID 83404
Phone (208) 522-2996

3910 Washington Pkwy
Ste C
Idaho Falls, ID 83404

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412208000000",
    "number": "1659301349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 WASHINGTON PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047596",
            "telephone_number": "208-529-8330",
            "fax_number": "208-884-4611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 E 25TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047542",
            "telephone_number": "208-529-8330",
            "fax_number": "208-523-3318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RM LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2014-10-02",
        "status": "A",
        "authorized_official_last_name": "CROFTS",
        "authorized_official_first_name": "VON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-523-1122"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ID",
            "license": "13D0520868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806230600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Express Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.