Physician Laboratory Services, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PHYSICIAN LABORATORY SERVICES, LLC

Practice address

2015 Jackson Creek
Edinburg, TX 78539

Phone

(956) 686-7236

Fax

(956) 686-7517

NPI assigned

Jul 14, 2006

Last updated

Jul 31, 2012By 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. Noe Rolando Medina

Title

Ceo

Phone

(956) 380-1281

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343692800000",
    "number": "1780600510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 JACKSON CREEK",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "78539",
            "telephone_number": "956-380-1281",
            "fax_number": "956-380-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 JACKSON CREEK",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "78539",
            "telephone_number": "956-686-7236",
            "fax_number": "956-686-7517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN LABORATORY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2012-07-31",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "NOE",
        "authorized_official_middle_name": "ROLANDO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "956-380-1281",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152576801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Edinburg, TX
• Providers in Edinburg, TX by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; 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.