NPIMap

Organization Active NPI

State of Alabama Department of Public Health

Doing business as Bureau of Clinical Labs

  • Clinical Medical Laboratory
  • Prattville, AL
National Provider Identifier
1982747192
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
01D0641691 Issued in AL
Legal business name
STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Doing business as
Bureau of Clinical Labs
Practice address
204 Legends CT
Prattville, AL 36066-7893
Phone
(334) 290-6130
NPI assigned
Feb 15, 2007
Last updated
Jan 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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

Authorized official

Name
Regina L Patterson
Title
Director of Health Systems
Phone
(334) 206-5061

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 01D0641691 AL Primary

Addresses

Primary practice location

204 Legends CT
Prattville, AL 36066-7893

Mailing address

PO Box 1000
Prattville, AL 36067-9901

Other identifiers 1

IdentifierTypeStateIssuer
000060117MedicaidAL

Other names 1

  • Bureau of Clinical Labs Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150729007760 AL Part B Supplier - Independent Clinical Laboratory 8022007970 Practice locations: Prattville, AL

Other NPIs with the same Medicare PAC ID 3

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
01D0641691Alabama Department of Public Health204 Legends Court, Prattville, AL 36066ComplianceJun 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Escambia County Health Dept-Brewton Mat1,340 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

8140 Aum Dr
Montgomery, AL 36117
Phone (334) 206-3400

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Alabama Department of Public Health Home CareMontgomery, AL, CCN 017000 Home health agency Operational/Managerial Control Jul 1, 1966

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705363200000",
    "number": "1982747192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360679901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 LEGENDS CT",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360667893",
            "telephone_number": "334-290-6130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "REGINA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTH SYSTEMS",
        "authorized_official_telephone_number": "334-206-5061"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AL",
            "license": "01D0641691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000060117",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bureau of Clinical Labs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prattville, AL

Sources for this page

Verify at the official NPI Registry.