Vidalia Lab Services, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

06012R Issued in GA

Legal business name

VIDALIA LAB SERVICES, INC

Practice address

801 McNatt St
Vidalia, GA 30474-8808

Phone

(912) 537-0622

Fax

(912) 537-0641

NPI assigned

Jul 11, 2006

Last updated

Apr 8, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Riley McDonald

Title

President

Phone

(912) 537-0622

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270684800000",
    "number": "1942234141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 MCNATT ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748808",
            "telephone_number": "912-537-0622",
            "fax_number": "912-537-0641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 MCNATT ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748808",
            "telephone_number": "912-537-0622",
            "fax_number": "912-537-0641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDALIA LAB SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2010-04-08",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "RILEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-537-0622"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "GA",
            "license": "06012R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "604767895A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00317736",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vidalia Health Services, LLC (Memorial Health Meadows Hospital Imaging Center)
• Vidalia Health Services, LLC
• Vidalia Health Services, LLC (Sleep Center-Vidalia, a department of Memorial Health Meadows Hospital)
• Vidalia Imaging Associates, LLC
• Vidalia Immediate & Primary Care LLC
• Vidalia Medical Associates, PC
• Vidalia Medical Partners Inc. (1st Choice Family Medical Group)
• Vidalia Neurology Associates, LLC
• Vidalia OB GYN
• Vidalia Open MRI, LLC

• Clinical Medical Laboratory in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; 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.