Organization Active NPI

Veedhata Om LLC

Doing business as Prime Diagnostics

  • Clinical Medical Laboratory
  • Valdosta, GA
National Provider Identifier
1831851039
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
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

Updated by the provider on Jan 12, 2023

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)CodeLicenseStatePrimary
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 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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).

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
11D2223235Veedhata Om LLC Dba Prime Diagnostics3386 Greystone Way, Valdosta, GA 31605AccreditationOct 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Veedhata Om LLC2 organizations share this tax ID, including this one

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.

Verify at the official NPI Registry.