Medical Arts Laboratory of New Smyrna Beach Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

800000003 Issued in FL

Legal business name

MEDICAL ARTS LABORATORY OF NEW SMYRNA BEACH INC

Practice address

257 N Causeway
New Smyrna Beach, FL 32169-5239

Phone

(386) 428-5745

Fax

(386) 427-6566

NPI assigned

May 8, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Douglas Glenn Bentley I, MT

Title

Owner President

Phone

(386) 428-5745

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388966400000",
    "number": "1861605396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 N CAUSEWAY",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321695239",
            "telephone_number": "386-428-5745",
            "fax_number": "386-427-6566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 N CAUSEWAY",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321695239",
            "telephone_number": "386-428-5745",
            "fax_number": "386-427-6566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ARTS LABORATORY OF NEW SMYRNA BEACH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2014-01-06",
        "status": "A",
        "authorized_official_last_name": "BENTLEY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "386-428-5745",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "MT"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "800000003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "10D0645062",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2014; 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.