NPIMap

Organization Active NPI

Self-Employed

  • Physiological Laboratory
  • Painesville, OH
National Provider Identifier
1689077125
Registry record updated Sep 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
License
47 Issued in OH
Legal business name
SELF-EMPLOYED
Practice address
95B Barley Dr
Painesville, OH 44077-5349
Phone
(440) 251-9701
NPI assigned
Sep 29, 2014
Last updated
Sep 29, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2014

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

Authorized official

Name
Delmesha Jackson, HOMEHEALTHNPI 1528461266
Title
Stna
Phone
(440) 251-9701

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X 47 OH Primary

Addresses

Primary practice location

95B Barley Dr
Painesville, OH 44077-5349

Mailing address

95B Barley Dr
Painesville, OH 44077-5349
Phone (440) 251-9701

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1411948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411948800000",
    "number": "1689077125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95B BARLEY DR",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "440775349",
            "telephone_number": "440-251-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95B BARLEY DR",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "440775349",
            "telephone_number": "440-251-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF-EMPLOYED",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-29",
        "last_updated": "2014-09-29",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DELMESHA",
        "authorized_official_title_or_position": "STNA",
        "authorized_official_telephone_number": "440-251-9701",
        "authorized_official_credential": "HOMEHEALTH"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "OH",
            "license": "47",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Painesville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2014; 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.