Allegiant Lab to Carolina Diagnostic Labs

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ALLEGIANT LAB TO CAROLINA DIAGNOSTIC LABS

Practice address

1000 Heritage Center Cir Ste 167
Round Rock, TX 78664-4463

Phone

(410) 868-8643

NPI assigned

Sep 16, 2024

Organization subpart

No

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

Authorized official

Name

Manoj Tyagi, PHD

Title

Ceo

Phone

(410) 868-8343

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

CLIA laboratory certificates

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

{
    "created_epoch": "1726444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1972330843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HERITAGE CENTER CIR STE 167",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786644463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HERITAGE CENTER CIR STE 167",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786644463",
            "telephone_number": "410-868-8643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLEGIANT LAB TO CAROLINA DIAGNOSTIC LABS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "TYAGI",
        "authorized_official_first_name": "MANOJ",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-868-8343",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; 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.