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MENTORUP LIFE LAB & CLINIC
NPI 1063104511
General Practice in Tuscaloosa, AL

Active since May 23, 2023
535 JACK WARNER PKWY NE STE G2, TUSCALOOSA, AL 35404(205) 771-2261 Get Directions Write a Review

NPPES record last updated: May 23, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mentorup Life Lab & Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MENTORUP LIFE LAB & CLINIC (NPI 1063104511) is a healthcare organization registered as a general practice in Tuscaloosa, Alabama and active in the NPI registry since May 2023. The organization lists Ellory Kate Johnson, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1063104511
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameMENTORUP LIFE LAB & CLINIC
Location Address535 JACK WARNER PKWY NE STE G2Tuscaloosa, AL 35404-5715
Mailing Address4202 20th St NeTuscaloosa, AL 35404-1502 · (205) 771-2261
Phone(205) 771-2261
Organization SubpartNo
Authorized OfficialEllory Kate JohnsonMedical Director · (205) 771-2261
Enumeration DateMay 23, 2023
NPPES CertifiedMay 23, 2023
✔ NPI 1063104511 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
535 JACK WARNER PKWY NE STE G2, Tuscaloosa, AL 35404
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MISS CHLOE SHELL MSW
Psychologist
535 JACK WARNER PKWY NE STE G2
TUSCALOOSA, AL 35404
Tuscaloosa County (703) 955-0473
ELLORY KATE JOHNSON MD
General Practice
535 JACK WARNER PKWY NE STE G2
TUSCALOOSA, AL 35404
Tuscaloosa County (205) 771-2261
FLOWSTATE PHYSICAL THERAPY AND INJURY PREVENTION LLC
Physical Therapist
535 JACK WARNER PKWY NE STE G2
TUSCALOOSA, AL 35404
Tuscaloosa County (205) 826-5536

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mentorup Life Lab & Clinic's NPI number?

The NPI number for Mentorup Life Lab & Clinic is 1063104511. It was assigned to this organization in the NPPES registry on May 23, 2023.

Where is Mentorup Life Lab & Clinic located?

Mentorup Life Lab & Clinic is located at 535 Jack Warner Pkwy NE Ste G2, Tuscaloosa, AL 35404. The listed phone number is (205) 771-2261.

What is Mentorup Life Lab & Clinic's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Mentorup Life Lab & Clinic was last updated on May 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.