NPIMap

Organization Active NPI

Laboratory Medicine Consultants LTD

  • Clinical Medical Laboratory
  • Las Vegas, NV
National Provider Identifier
1962463786
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
LABORATORY MEDICINE CONSULTANTS LTD
Practice address
7455 W Washington Ave
Suite 301
Las Vegas, NV 89128-4337
Phone
(702) 732-2310
Fax
(702) 732-2310
NPI assigned
Mar 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Authorized official

Name
Michael C. Grattendick
Title
Vice President
Phone
(561) 626-5512

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

7455 W Washington Ave
Suite 301
Las Vegas, NV 89128-4337

Mailing address

11025 Rca Center Drive
Suite 300
Palm Beach Gardens, FL 33410-4269
Phone (561) 626-5512

Other identifiers 1

IdentifierTypeStateIssuer
100513165MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040403000179 NV Part B Supplier - Independent Clinical Laboratory 4183617533 Practice locations: Las Vegas, NV; Mesquite, NV; Henderson, NV
O20080519000594 AZ Part B Supplier - Clinic/Group Practice 4183617533 Receives reassigned benefits from 40 practitioners
Practice locations: Parker, AZ; Fort Mohave, AZ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D0976712Laboratory Medicine Consultant, LTD7455 W Washington Ave Ste 301, Las Vegas, NV 89128AccreditationJul 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lab Medicine Consultants LTD2 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.

Locations

2755 Silver Creek Rd
Ste 227
Bullhead City, AZ 86442

2460 SW Perkins Ave
Pendleton, OR 97801
Phone (541) 647-0970

1355 River Bend Dr
Dallas, TX 75247
Phone (214) 237-1818

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1962463786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11025 RCA CENTER DRIVE",
            "address_2": "SUITE 300",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104269",
            "telephone_number": "561-626-5512",
            "fax_number": "561-626-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7455 W WASHINGTON AVE",
            "address_2": "SUITE 301",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891284337",
            "telephone_number": "702-732-2310",
            "fax_number": "702-732-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORY MEDICINE CONSULTANTS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "GRATTENDICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "561-626-5512"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100513165",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.