NOVUS LABORATORIES, LLC - NPI NUMBER 1760743090

Summary

Provider Name: NOVUS LABORATORIES, LLC

NPI Number: 1760743090

Clasification: Clinical Medical Laboratory (291U00000X)

Address:
14270 LEE HWY
BRISTOL, VA
ZIP 24202

Phone Number: (276) 525-4606



Detailed Information

NOVUS LABORATORIES, LLC is a clinical medical laboratory in Bristol, VA. The provider is (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. The assigned NPI number for this provider is 1760743090 and is registered as an organization entity type.

The provider's business address is:

14270 LEE HWY
BRISTOL, VA
ZIP 24202-316
Phone: (276) 525-4606
Fax: (276) 525-4608

The provider's authorized official is Tera W Coulter .
The authorized official title is Director Of Laboratory Operations and has the following contact phone number (276) 525-4606.

The enumeration date for this NPI number is 6/4/2012 and was last updated on 5/6/2014.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 291U00000X Clinical Medical Laboratory 49D2042544 VA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 1530278 MEDICAID TN
2 1760743090 MEDICAID VA
3 49D2042544 MEDICARE OSCAR/CERTIFICATION VA
4 49D2042544 OTHER VA CLIA
5 Q407300001 MEDICARE UPIN
6 4334814 OTHER TN BC/BS
7 1760743090 MEDICARE PIN

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1760743090 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name NOVUS LABORATORIES, LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 14270 LEE HWY The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name BRISTOL The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name VA The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 242024316 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 2765254606 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 2765254608 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 6/4/2012 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 5/6/2014 The date that a record was last updated or changed.
14 Authorized Official Last Name COULTER The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name TERA The first name of the authorized official.
16 Authorized Official Middle Name W The middle name of the authorized official.
17 Authorized Official Title or Position DIRECTOR OF LABORATORY OPERATIONS The title or position of the authorized official.
18 Authorized Official Telephone Number 2765254606 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 291U00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Provider License Number 1 49D2042544 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
21 Provider License Number State Code 1 VA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 1530278 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier State 1 TN
26 Other Provider Identifier 2 1760743090 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier State 2 VA
29 Other Provider Identifier 3 49D2042544 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 3 06 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier State 3 VA
32 Other Provider Identifier 4 49D2042544 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
33 Other Provider Identifier Type Code 4 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier State 4 VA
35 Other Provider Identifier Issuer 4 CLIA
36 Other Provider Identifier 5 Q407300001 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
37 Other Provider Identifier Type Code 5 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
38 Other Provider Identifier 6 4334814 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
39 Other Provider Identifier Type Code 6 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
40 Other Provider Identifier State 6 TN
41 Other Provider Identifier Issuer 6 BC/BS
42 Other Provider Identifier 7 1760743090 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
43 Other Provider Identifier Type Code 7 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
44 Is Organization Subpart N
45 Authorized Official Name Prefix Text MS.
46 Authorized Official Credential Text A.S.

Similar Providers Nearby

NPI Provider Name NPI Type Taxonomy
1447410642 BRISTOL LABORATORIES, LLC Organization Clinical Medical Laboratory


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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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