Edl Medical, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

1363 Issued in MS

Legal business name

EDL MEDICAL, LLC

Practice address

39 David Swan LN
Purvis, MS 39475-3076

Phone

(601) 794-2300

Fax

(601) 794-2500

NPI assigned

Apr 16, 2015

Last updated

Jan 30, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jonathan Stephens

Title

Director

Phone

(601) 794-2300

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706572800000",
    "number": "1891182812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 DAVID SWAN LN",
            "city": "PURVIS",
            "state": "MS",
            "postal_code": "394753076",
            "telephone_number": "601-794-2300",
            "fax_number": "601-794-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 DAVID SWAN LN",
            "city": "PURVIS",
            "state": "MS",
            "postal_code": "394753076",
            "telephone_number": "601-794-2300",
            "fax_number": "601-794-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDL MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-16",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-794-2300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MS",
            "license": "1363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Purvis, MS
• Providers in Purvis, MS by specialty
• Clinical Medical Laboratory in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.