Envision Medical Management LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ENVISION MEDICAL MANAGEMENT LLC

Practice address

4927 Lake Ridge Pkwy Ste 148
Grand Prairie, TX 75052-3087

Phone

(313) 505-2932

NPI assigned

Dec 19, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Chaitanya Chavda, MD

Title

Director

Phone

(313) 505-2932

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1639872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639872000000",
    "number": "1811657828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4927 LAKE RIDGE PKWY STE 148",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4927 LAKE RIDGE PKWY STE 148",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523087",
            "telephone_number": "313-505-2932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISION MEDICAL MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-19",
        "last_updated": "2021-12-19",
        "certification_date": "2021-12-19",
        "status": "A",
        "authorized_official_last_name": "CHAVDA",
        "authorized_official_first_name": "CHAITANYA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "313-505-2932",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Grand Prairie, TX
• Providers in Grand Prairie, 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 Dec 19, 2021; 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.