Lab One LLC
Organization Active NPI Clinical Medical Laboratory · Macon, MO
NPI 1922583731 · NPPES record last updated Sep 27, 2018
Key facts
- NPI
- 1922583731
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Legal business name
- LAB ONE LLC
- Practice address
- 404 Providence Rd
Macon, MO 63552-4222 - Phone
- (660) 395-8914
- NPI assigned
- Sep 27, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- QUEST DIAGNOSTICS INCORPORATED
Authorized official
- Name
- Charles Albert Bowles
- Title
- Vice President
- Phone
- (610) 454-4122
Other NPIs on the same Medicare enrollment 22
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070605000598 | MO | Part B Supplier - Independent Clinical Laboratory | 9931008893 |
41 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Columbia, MO; Springfield, MO; Poplar Bluff, MO; Mexico, MO; Kansas City, MO; Joplin, MO |
National Provider Directory
- Part of
- Questdiagnost Ic Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
404 Providence Rd
Macon, MO 63552-4222
Mailing address
1201 S Collegeville Rd
Collegeville, PA 19426-2998
Phone (214) 932-8018
NPI Registry JSON
{
"created_epoch": "1538006400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1538006400000",
"number": "1922583731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 S COLLEGEVILLE RD",
"city": "COLLEGEVILLE",
"state": "PA",
"postal_code": "194262998",
"telephone_number": "214-932-8018",
"fax_number": "610-271-4245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 PROVIDENCE RD",
"city": "MACON",
"state": "MO",
"postal_code": "635524222",
"telephone_number": "660-395-8914"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAB ONE LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "QUEST DIAGNOSTICS INCORPORATED",
"enumeration_date": "2018-09-27",
"last_updated": "2018-09-27",
"status": "A",
"authorized_official_last_name": "BOWLES",
"authorized_official_first_name": "CHARLES",
"authorized_official_middle_name": "ALBERT",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "610-454-4122"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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All providers in Macon, MO · Clinical Medical Laboratory in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.