Peacock Medical LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PEACOCK MEDICAL LLC

Practice address

1091 SW Bayshore Blvd
Port St Lucie, FL 34983-2463

Phone

(772) 340-3313

NPI assigned

Oct 29, 2010

Organization subpart

No

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

Authorized official

Name

Karen Barlow

Title

President, Jupiter Professional Dev

Phone

(561) 748-2889

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1288310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372118400000",
    "number": "1679873236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 HOOD RD",
            "address_2": "SUITE 101",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334188910",
            "telephone_number": "561-748-2889",
            "fax_number": "561-748-1523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1091 SW BAYSHORE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349832463",
            "telephone_number": "772-340-3313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACOCK MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-29",
        "last_updated": "2013-06-25",
        "status": "A",
        "authorized_official_last_name": "BARLOW",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "PRESIDENT, JUPITER PROFESSIONAL DEV",
        "authorized_official_telephone_number": "561-748-2889"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; 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.