MENTORUP LIFE LAB & CLINIC – NPI #1063104511
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

MENTORUP LIFE LAB & CLINIC is a provider located in TUSCALOOSA, AL. NPPES has assigned the NPI number 1063104511 to MENTORUP LIFE LAB & CLINIC on May 23, 2023. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 208D00000X from the Health Care Provider Taxonomy code set, which is classified as General Practice.

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MENTORUP LIFE LAB & CLINIC below.

NPI Profile for
MENTORUP LIFE LAB & CLINIC

NPI Number
1063104511
Enumeration Date

(more than 3 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
MENTORUP LIFE LAB & CLINIC
Primary location
535 JACK WARNER PKWY NE STE G2
TUSCALOOSA, AL 35404-5715
Phone: (205) 771-2261 Fax:
Mailing address
4202 20TH ST NE
TUSCALOOSA, AL 35404-1502
Phone: (205) 771-2261 Fax:
Organization Subpart
No
Authorized Official
ELLORY JOHNSON
MEDICAL DIRECTOR
Phone: (205) 771-2261
Updated
Certification Date
May 23, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
208D00000X
- General Practice (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.