Stat Diagnostic Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

STAT DIAGNOSTIC LAB LLC

Practice address

509 N Hampton Rd
Suite 204
Desoto, TX 75115-4970

Phone

(972) 230-2323

Fax

(972) 230-2324

NPI assigned

Feb 23, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Delia Delores Booker

Title

President

Phone

(214) 434-4032

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1902931207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 COLONIAL AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752154140",
            "telephone_number": "214-434-4032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 N HAMPTON RD",
            "address_2": "SUITE 204",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751154970",
            "telephone_number": "972-230-2323",
            "fax_number": "972-230-2324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAT DIAGNOSTIC LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "BOOKER",
        "authorized_official_first_name": "DELIA",
        "authorized_official_middle_name": "DELORES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-434-4032",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "20449",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D1064567",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Desoto, TX
• Providers in Desoto, 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 Jun 5, 2008; 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.