Prodigy Toxicology LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

45D2084574 Issued in TX

Legal business name

PRODIGY TOXICOLOGY LLC

Practice address

3861 Long Prairie Rd Ste 109
Flower Mound, TX 75028-1799

Phone

(214) 513-8700

Fax

(214) 513-8730

NPI assigned

Oct 8, 2014

Organization subpart

No

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

Authorized official

Name

Kim Sivaraman

Title

Billing Manager

Phone

(214) 618-5600

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413849600000",
    "number": "1881097509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5566 MAIN ST STE 210",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750333673",
            "telephone_number": "214-618-5600",
            "fax_number": "214-618-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3861 LONG PRAIRIE RD STE 109",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750281799",
            "telephone_number": "214-513-8700",
            "fax_number": "214-513-8730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGY TOXICOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-08",
        "last_updated": "2014-10-21",
        "status": "A",
        "authorized_official_last_name": "SIVARAMAN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "214-618-5600"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D2084574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D2084574",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Flower Mound, TX
• Providers in Flower Mound, 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 Oct 21, 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.