Active NPI
Bostwick Laboratories, Inc.
- Clinical Medical Laboratory
- Glen Allen, VA
National Provider Identifier
1952465288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- BOSTWICK LABORATORIES, INC.
- Practice address
- 4851 Lake Brook Dr
Glen Allen, VA 23060-9233 - Phone
- (804) 967-9225
- Fax
- (804) 239-1954
- NPI assigned
- Dec 21, 2006
- Reactivated
- Feb 27, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. David Granger Bostwick, MD
- Title
- Ceo, President, Chief Med. Officer
- Phone
- (804) 967-9225
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary |
Addresses
Primary practice location
4851 Lake Brook Dr
Glen Allen, VA 23060-9233
Mailing address
PO Box 403751
Atlanta, GA 30384-3751
Phone (804) 967-9225
Other identifiers 42
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036874800 | Medicaid | DC | |
| 0578229 | Medicaid | IA | |
| 100503849 | Medicaid | NV | |
| 1198722 | Medicaid | LA | |
| 120124700 | Medicaid | WY | |
| 164650710 | Medicaid | MI | |
| 419300000 | Medicaid | ME | |
| 6701112000 | Medicaid | WV | |
| 690000006 | Medicaid | AL | |
| 010062811 | Medicaid | VA | |
| 2420571 | Medicaid | OH | |
| 4582490 | Medicaid | TN | |
| 0421311 | Medicaid | MT | |
| 200262210A | Medicaid | KS | |
| 32287232 | Medicaid | CO | |
| 409261900 | Medicaid | MD | |
| 706132305 | Medicaid | MO | |
| 7123995 | Medicaid | WA | |
| 8069026 | Medicaid | ID | |
| L00184 | Medicaid | SC | |
| 01837399 | Medicaid | MS | |
| 32940800 | Medicaid | WI | |
| 911980900 | Medicaid | FL | |
| 138056 | Other | VA | ANTHEM BCBS OF VIRGINIA |
| 152979709 | Medicaid | AR | |
| 533631 | Other | AZ | MERCY CARE PLAN |
| 568644630A | Medicaid | GA | |
| 1009021320002 | Medicaid | PA | |
| 164040101 | Medicaid | TX | |
| 190000932 | Other | VA | MEDICARE PTAN |
| 20073351 | Other | SC | SC SELECT HEALTH /MEDICAID HMO |
| 275326 MCD | Medicaid | OR | |
| 440615 | Medicaid | AZ | |
| 82083339 | Medicaid | NM | |
| 000000265139 | Other | OH | UNISON HEALTH (OH MEDICAID HMO) |
| 036874800 | Other | DC | DC MEDICAID (ACS) |
| 1900009 | Medicaid | RI | |
| 1952465288 | Medicaid | MN | |
| 200024720A | Medicaid | OK | |
| 200375010A | Medicaid | IN | |
| 37000718 | Medicaid | KY | |
| 7001242 | Medicaid | NC |
National Provider Directory
National Provider DirectoryLocations
4851 Lake Brook Dr
Glen Allen, VA 23060
Phone (800) 214-6628
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1337644800000",
"number": "1952465288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 403751",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303843751",
"telephone_number": "804-967-9225",
"fax_number": "804-239-1954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4851 LAKE BROOK DR",
"city": "GLEN ALLEN",
"state": "VA",
"postal_code": "230609233",
"telephone_number": "804-967-9225",
"fax_number": "804-239-1954"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BOSTWICK LABORATORIES, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-21",
"last_updated": "2012-05-22",
"deactivation_date": "2011-10-06",
"reactivation_date": "2012-02-27",
"status": "A",
"authorized_official_last_name": "BOSTWICK",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "GRANGER",
"authorized_official_title_or_position": "CEO, PRESIDENT, CHIEF MED. OFFICER",
"authorized_official_telephone_number": "804-967-9225",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
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"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
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"primary": true
}
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{
"code": "05",
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{
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"identifier": "20073351",
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"code": "05",
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"identifier": "1900009",
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{
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"issuer": null,
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{
"code": "05",
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"issuer": null,
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"code": "05",
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],
"endpoints": [],
"other_names": []
}Other providers in Glen Allen, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.