NPIMap

Organization Active NPI

Boston Clinical Laboratory

  • Specialist
  • Norwood, MA
National Provider Identifier
1922076447
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
39080 Issued in MA
Legal business name
BOSTON CLINICAL LABORATORY
Practice address
100 River Ridge Dr
Norwood, MA 02062-5030
Phone
(781) 255-0555
Fax
(781) 255-0594
NPI assigned
Mar 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Diane Shea
Title
Manager
Phone
(781) 255-0555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 39080 MA Primary

Addresses

Primary practice location

100 River Ridge Dr
Norwood, MA 02062-5030

Mailing address

100 River Ridge Dr
Norwood, MA 02062-5030
Phone (781) 255-0555

Other identifiers 1

IdentifierTypeStateIssuer
0805912MedicaidMA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922076447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RIVER RIDGE DR",
            "city": "NORWOOD",
            "state": "MA",
            "postal_code": "020625030",
            "telephone_number": "781-255-0555",
            "fax_number": "781-255-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RIVER RIDGE DR",
            "city": "NORWOOD",
            "state": "MA",
            "postal_code": "020625030",
            "telephone_number": "781-255-0555",
            "fax_number": "781-255-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON CLINICAL LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHEA",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "781-255-0555"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MA",
            "license": "39080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0805912",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwood, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.