Summit Clinical Laboratory, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SUMMIT CLINICAL LABORATORY, LLC

Practice address

17742 Preston Rd # 205
Dallas, TX 75252-6199

Phone

(214) 687-2392

Fax

(214) 602-7003

NPI assigned

Apr 14, 2020

Organization subpart

No

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

Authorized official

Name

Oscar Dereva

Title

Director

Phone

(214) 687-2392

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter Dereva

  • Clinical Medical Laboratory
  • Nashville, TN
  • NPI 1588283063
  NPD

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

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1902425440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 CASCADE COVE DR",
            "city": "LITTLE ELM",
            "state": "TX",
            "postal_code": "750687607",
            "telephone_number": "214-687-2392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17742 PRESTON RD # 205",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752526199",
            "telephone_number": "214-687-2392",
            "fax_number": "214-602-7003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Glen Echo Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372152857",
            "country_code": "US",
            "telephone_number": "214-687-2392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUMMIT CLINICAL LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "DEREVA",
        "authorized_official_first_name": "OSCAR",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "214-687-2392"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grayce Carole Summers, PA-C
• Kayla Summers, PA-C
• Laura Summers, MS, LMFT
• Summerville at Lakeland Hills Associates, LP
• Summit Anesthesiology Associates, PLLC
• Summit Emergency Holdings, LLC
• Summit Emergency Medicine, PLLC
• Summit Emergency Medicine, PLLC
• Summit Emergency Medicine, PLLC
• Summit Emergency Medicine, PLLC

• Clinical Medical Laboratory in Dallas, TX
• Providers in Dallas, 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 Sep 15, 2020; 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.