NPIMap

Organization Active NPI

Nexus Lab 2.0 LLC

  • Clinical Medical Laboratory
  • Cookeville, TN
National Provider Identifier
1811271653
Registry record updated Sep 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
NEXUS LAB 2.0 LLC
Practice address
1711 S Jefferson Ave
Cookeville, TN 38506-5581
Phone
(270) 858-3341
Fax
(931) 525-1122
NPI assigned
Sep 28, 2011
Organization subpart
Yes
Parent organization
PREMIERTOX 2.0, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2011

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

Authorized official

Name
Robert L. Bertram, M.D.NPI 1417008756
Title
Managing Partner
Phone
(270) 866-8881

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

1711 S Jefferson Ave
Cookeville, TN 38506-5581

Mailing address

PO Box 1038
Frankfort, KY 40602-1038
Phone (502) 226-3858

National Provider Directory

National Provider Directory
Tax ID family
Nexus Lab 20 LLC5 organizations share this tax ID, including this one
Part of
Premiertox 2 0 Inc

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317168000000",
    "number": "1811271653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1038",
            "city": "FRANKFORT",
            "state": "KY",
            "postal_code": "406021038",
            "telephone_number": "502-226-3858",
            "fax_number": "502-223-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 S JEFFERSON AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385065581",
            "telephone_number": "270-858-3341",
            "fax_number": "931-525-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEXUS LAB 2.0 LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIERTOX 2.0, INC.",
        "enumeration_date": "2011-09-28",
        "last_updated": "2011-09-28",
        "status": "A",
        "authorized_official_last_name": "BERTRAM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "270-866-8881",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; 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.