Provider Laboratory Services LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PROVIDER LABORATORY SERVICES LLC

Practice address

88 Oxford St
Lewiston, ME 04240-7825

Phone

(207) 241-7722

Fax

(207) 312-5677

NPI assigned

Sep 1, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Tom Vurgason

Title

General Partner

Phone

(207) 333-3278

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484006400000",
    "number": "1972970341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1150",
            "address_2": "306 RODMAN ROAD",
            "city": "AUBURN",
            "state": "ME",
            "postal_code": "042111150",
            "telephone_number": "207-333-3278",
            "fax_number": "207-333-3037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 OXFORD ST",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407825",
            "telephone_number": "207-241-7722",
            "fax_number": "207-312-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDER LABORATORY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-01",
        "last_updated": "2017-01-10",
        "status": "A",
        "authorized_official_last_name": "VURGASON",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "207-333-3278",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Brooke Proulx, LMSW
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• Deborah J Puckhaber, MD
• Alisha Pulkkinen
• Jessica C. Pulkkinen, LCSW
• Erica Pulsoni-Draper, CADC, MHRT/C

• All providers in Lewiston, ME
• Clinical Medical Laboratory in Maine

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