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

Similar Providers

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





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
1 NPI 1760743090
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name NOVUS LABORATORIES, LLC
5 Provider First Line Business Practice Location Address 14270 LEE HWY
6 Provider Business Practice Location Address City Name BRISTOL
7 Provider Business Practice Location Address State Name VA
8 Provider Business Practice Location Address Postal Code 242024316
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 2765254606
11 Provider Business Practice Location Address Fax Number 2765254608
12 Provider Enumeration Date 6/4/2012
13 Last Update Date 5/6/2014
14 Authorized Official Last Name COULTER
15 Authorized Official First Name TERA
16 Authorized Official Middle Name W
17 Authorized Official Title or Position DIRECTOR OF LABORATORY OPERATIONS
18 Authorized Official Telephone Number 2765254606
19 Healthcare Provider Taxonomy Code 1 291U00000X
20 Provider License Number 1 49D2042544
21 Provider License Number State Code 1 VA
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 1530278
24 Other Provider Identifier Type Code 1 05
25 Other Provider Identifier State 1 TN
26 Other Provider Identifier 2 1760743090
27 Other Provider Identifier Type Code 2 05
28 Other Provider Identifier State 2 VA
29 Other Provider Identifier 3 49D2042544
30 Other Provider Identifier Type Code 3 06
31 Other Provider Identifier State 3 VA
32 Other Provider Identifier 4 49D2042544
33 Other Provider Identifier Type Code 4 01
34 Other Provider Identifier State 4 VA
35 Other Provider Identifier Issuer 4 CLIA
36 Other Provider Identifier 5 Q407300001
37 Other Provider Identifier Type Code 5 02
38 Other Provider Identifier 6 4334814
39 Other Provider Identifier Type Code 6 01
40 Other Provider Identifier State 6 TN
41 Other Provider Identifier Issuer 6 BC/BS
42 Other Provider Identifier 7 1760743090
43 Other Provider Identifier Type Code 7 08
44 Is Organization Subpart N
45 Authorized Official Name Prefix Text MS.
46 Authorized Official Credential Text A.S.

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This page was last updated on: 10/12/2014
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