NPIMap

Organization Active NPI

Laboratorio Clinico Jardines, Inc.

Doing business as Lab Clinico Jardines de Country Club

  • Clinical Medical Laboratory
  • Carolina, PR
National Provider Identifier
1932386323
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
0685 Issued in PR
Legal business name
LABORATORIO CLINICO JARDINES, INC.
Doing business as
Lab Clinico Jardines de Country Club
Practice address
Be5 Calle 101
Jardines de Country Club
Carolina, PR 00983-2189
Phone
(787) 752-0504
Fax
(787) 768-5818
NPI assigned
Jan 28, 2008
Last updated
Sep 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

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

Authorized official

Name
Edwin W Vazquez
Title
Administrator
Phone
(787) 752-0504

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 0685 PR Primary

Addresses

Primary practice location

Be5 Calle 101
Jardines de Country Club
Carolina, PR 00983-2189

Mailing address

PO Box 3278
Carolina, PR 00984-3278
Phone (787) 752-0504

Other names 1

  • Lab Clinico Jardines de Country Club Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130904000970 PR Part B Supplier - Independent Clinical Laboratory 6709033186 2 other NPIs on this enrollment
Practice locations: Carolina, PR

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Lab Clinico Jardines2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1932386323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3278",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009843278",
            "telephone_number": "787-752-0504",
            "fax_number": "787-768-5818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BE5 CALLE 101",
            "address_2": "JARDINES DE COUNTRY CLUB",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009832189",
            "telephone_number": "787-752-0504",
            "fax_number": "787-768-5818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO JARDINES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-28",
        "last_updated": "2012-09-28",
        "status": "A",
        "authorized_official_last_name": "VAZQUEZ",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "787-752-0504"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "0685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lab Clinico Jardines de Country Club",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carolina, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.