Innovative Pathology Laboratory Service

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

45D209495 Issued in TX

Legal business name

INNOVATIVE PATHOLOGY LABORATORY SERVICE

Practice address

1475 FM 1960 Bypass Rd E
Humble, TX 77338-3909

Phone

(713) 416-7749

NPI assigned

Nov 9, 2015

Last updated

Nov 9, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Randy Butler

Title

Administrator

Phone

(713) 416-7749

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1447027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447027200000",
    "number": "1780057026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 FM 1960 BYPASS RD E",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773383909",
            "telephone_number": "713-416-7749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 FM 1960 BYPASS RD E",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773383909",
            "telephone_number": "713-416-7749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PATHOLOGY LABORATORY SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-09",
        "last_updated": "2015-11-09",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "713-416-7749",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D209495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D2099495",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Humble, TX
• Providers in Humble, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; 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.