Organization Active NPI

Mci Diagnostic Center, LLC

  • Clinical Medical Laboratory
  • Richardson, TX
National Provider Identifier
1750466587
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MCI DIAGNOSTIC CENTER, LLC
Practice address
1155 Kas Dr Ste 180
Richardson, TX 75081-1970
Phone
(469) 485-2382
Fax
(918) 744-9729
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

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

Authorized official

Name
Mrs. Colleen J Payne, R.T.
Title
Director
Phone
(469) 485-2382

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X 2-S-2821 OK

Addresses

Primary practice location

1155 Kas Dr Ste 180
Richardson, TX 75081-1970

Mailing address

7018 S Utica Ave
Tulsa, OK 74136-3907
Phone (918) 744-1001

Other identifiers 1

IdentifierTypeStateIssuer
200031560BMedicaidOK

Other names 1

  • MCI Diagnostic Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Dallas Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211214000295 TX Part B Supplier - Independent Clinical Laboratory 8123090511 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Richardson, TX

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1331 W Will Rogers Blvd
Claremore, OK 74017
Phone (918) 343-8800

7018 S Utica Ave
Tulsa, OK 74136
Phone (918) 523-2600

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1750466587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7018 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363907",
            "telephone_number": "918-744-1001",
            "fax_number": "918-744-9729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 KAS DR STE 180",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750811970",
            "telephone_number": "469-485-2382",
            "fax_number": "918-744-9729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCI DIAGNOSTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-17",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "469-485-2382",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.T."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OK",
            "license": "2-S-2821",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200031560B",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Dallas",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1155 Kas Dr Ste 180",
            "city": "Richardson",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750811970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MCI Diagnostic Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MCI Diagnostic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richardson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; 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.