Physicians Group Laboratories, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PHYSICIANS GROUP LABORATORIES, LLC

Practice address

4752 Highway 311 Ste 112
Houma, LA 70360-2810

Phone

(985) 580-7903

Fax

(985) 580-9704

NPI assigned

Jun 27, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Andrew Yeates

Title

Ceo

Phone

(985) 580-9703

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PGL Other name

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671667200000",
    "number": "1760897755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4752 HIGHWAY 311 STE 112",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703602810",
            "telephone_number": "985-580-7903",
            "fax_number": "985-580-9704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4752 HIGHWAY 311 STE 112",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703602810",
            "telephone_number": "985-580-7903",
            "fax_number": "985-580-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS GROUP LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-27",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A",
        "authorized_official_last_name": "YEATES",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "985-580-9703",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "19D2079393",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PGL",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "PGL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinical Medical Laboratory in Houma, LA
• Providers in Houma, LA by specialty
• Clinical Medical Laboratory in Louisiana

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