Acadian Diagnostic Laboratories LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ACADIAN DIAGNOSTIC LABORATORIES LLC

Practice address

2500 S Decker Lake Blvd Ste 4
West Valley City, UT 84119-5782

Phone

(225) 448-5886

Fax

(225) 292-5956

NPI assigned

Sep 29, 2017

Last updated

Oct 25, 2019By 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

Terry S Wilks Jr.

Title

Owner/Ceo

Phone

(225) 448-5886

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1506643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571961600000",
    "number": "1891204160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11842 JUSTICE AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708165324",
            "telephone_number": "225-448-5886",
            "fax_number": "225-292-5956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 S DECKER LAKE BLVD STE 4",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841195782",
            "telephone_number": "225-448-5886",
            "fax_number": "225-292-5956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADIAN DIAGNOSTIC LABORATORIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-29",
        "last_updated": "2019-10-25",
        "status": "A",
        "authorized_official_last_name": "WILKS",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "225-448-5886",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "46D2114570",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; 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.