Active NPI
Veedhata Om LLC
Doing business as Prime Diagnostics
- Clinical Medical Laboratory
- Valdosta, GA
National Provider Identifier
1831851039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- VEEDHATA OM LLC
- Doing business as
- Prime Diagnostics
- Practice address
- 3386 Greystone Way
Valdosta, GA 31605-1096 - Phone
- (229) 262-7777
- NPI assigned
- Oct 6, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Rachana Patel, B.PHARM,MS,MB(ASCP)
- Title
- Owner
- Phone
- (229) 262-7777
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary |
Addresses
Primary practice location
3386 Greystone Way
Valdosta, GA 31605-1096
Mailing address
3386 Greystone Way
Valdosta, GA 31605-1096
Phone (229) 262-7777
Other names 1
- PRIME DIAGNOSTICS
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211117001187 | GA | Part B Supplier - Independent Clinical Laboratory | 9537558333 | Practice locations: Valdosta, GA |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Prime Diagnostics
- Clinical Medical Laboratory
- Lake City, FL
- NPI 1720810328
9537558333
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2223235 | Veedhata Om LLC Dba Prime Diagnostics | Accreditation | Oct 31, 2026 |
National Provider Directory
National Provider Directory- Tax ID family
- Veedhata Om LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Locations
3386 Greystone Way
Valdosta, GA 31605
Phone (229) 219-7826
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633478400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1673481600000",
"number": "1831851039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3386 GREYSTONE WAY",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316051096",
"telephone_number": "229-262-7777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3386 GREYSTONE WAY",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316051096",
"telephone_number": "229-262-7777"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VEEDHATA OM LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-10-06",
"last_updated": "2023-01-12",
"certification_date": "2023-01-12",
"status": "A",
"authorized_official_last_name": "PATEL",
"authorized_official_first_name": "RACHANA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "229-262-7777",
"authorized_official_credential": "B.PHARM,MS,MB(ASCP)"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "PRIME DIAGNOSTICS",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "PRIME DIAGNOSTICS",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.