NPIMap

Organization Active NPI

Southern Diagnostic Laboratories, LLC

  • Clinical Medical Laboratory
  • Jasper, AL
National Provider Identifier
1780990564
Registry record updated Aug 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
SOUTHERN DIAGNOSTIC LABORATORIES, LLC
Practice address
1450 Jones Dairy Rd
Jasper, AL 35501-6106
Phone
(205) 387-2113
Fax
(205) 387-2425
NPI assigned
Aug 31, 2010
Last updated
Aug 31, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2010

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

Authorized official

Name
Mr. Ross W Jones
Title
Billing Manager
Phone
(334) 358-5966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

1450 Jones Dairy Rd
Jasper, AL 35501-6106

Mailing address

2732 7TH Ave S
Birmingham, AL 35233-3406

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D1106300Walker Medical Diagnostic LLC1450 Jones Dairy Road BLDG, Jasper, AL 35501Certificate of waiverOct 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Southern Diagnostic Laboratories LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283212800000",
    "number": "1780990564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2732 7TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352333406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 JONES DAIRY RD",
            "city": "JASPER",
            "state": "AL",
            "postal_code": "355016106",
            "telephone_number": "205-387-2113",
            "fax_number": "205-387-2425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DIAGNOSTIC LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-31",
        "last_updated": "2010-08-31",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "334-358-5966",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.