Carolina Medical Lab Group Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

34D0946272 Issued in NC

Legal business name

CAROLINA MEDICAL LAB GROUP INC.

Practice address

1815 Back Creek Dr
Charlotte, NC 28213-2159

Phone

(704) 598-8818

NPI assigned

Jun 15, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Osama Idlibi

Title

Vice President

Phone

(704) 598-8818

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Tax ID family

Carolina Medical Lab Group Inc2 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.

• Florida Medical Lab

  • Clinical Medical Laboratory
  • Panama City, FL
  • NPI 1144001074
  NPD tax ID

Locations

Practitioners 1

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

• Omar Idlibi, MD

  • Anatomic Pathology Physician
  • Charlotte, NC
  • NPI 1962407189

  Clinical Pathology

  Medicare reassignment NPD

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248652800000",
    "number": "1992700124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 BACK CREEK DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282132159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 BACK CREEK DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282132159",
            "telephone_number": "704-598-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA MEDICAL LAB GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-15",
        "last_updated": "2009-07-27",
        "status": "A",
        "authorized_official_last_name": "IDLIBI",
        "authorized_official_first_name": "OSAMA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "704-598-8818",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NC",
            "license": "34D0946272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7001214",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolina Injury Rehab PLLC
• Carolina Integrative Care PLLC
• Carolina Kidz Therapy, LLC
• Carolina Kinder Development LLC
• Carolina Kinder Development LLC
• Carolina Medicorp Enterprises Inc
• Carolina Medicorp Enterprises Inc
• Carolina Medicorp Enterprises Inc
• Carolina Medicorp Enterprises Inc
• Carolina Medicorp Enterprises Inc

• Clinical Medical Laboratory in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Medical Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; 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.