Statlab Mobile LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

STATLAB MOBILE LLC

Practice address

19101 SW 108TH Ave Unit 4
Cutler Bay, FL 33157-6783

Phone

(844) 469-5227

NPI assigned

Nov 3, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Cheveral Deacon, ASPT

Title

President

Phone

(305) 491-3809

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1383436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494374400000",
    "number": "1952730764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19101 SW 108TH AVE UNIT 4",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331576783",
            "telephone_number": "844-469-5227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19101 SW 108TH AVE UNIT 4",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331576783",
            "telephone_number": "844-469-5227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATLAB MOBILE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-03",
        "last_updated": "2017-05-10",
        "status": "A",
        "authorized_official_last_name": "DEACON",
        "authorized_official_first_name": "CHEVERAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-491-3809",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ASPT"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016241900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Cutler Bay, FL
• Providers in Cutler Bay, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; 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.