The 21 Club of Cny Inc · Clinical Medical Laboratory

12828 Willow Centre Dr Ste D, Houston, TX 77066-3043

Overview

The 21 Club of Cny Inc is a Clinical Medical Laboratory (organization) practicing in Houston, Texas. The National Provider Identifier (NPI) is #1477410090, which was assigned on January 6, 2026, and the registration record was last updated on February 13, 2026. The practitioner's main practice location is at 12828 Willow Centre Dr Ste D, Houston, TX 77066-3043; the contact telephone number is 7137662796, and the fax number is 7122195827. The primary taxonomy of The 21 Club of Cny Inc is Clinical Medical Laboratory (291U00000X). The authorized official for The 21 Club of Cny Inc is Carolyn Waldron (Owner).

(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.

Provider Information

NPI 1477410090
Entity Type Organization
Organization Name THE 21 CLUB OF CNY INC
Provider Name THE 21 CLUB OF CNY INC
Practice Address 12828 Willow Centre Dr Ste D
Houston
TX 77066-3043
Practice Telephone 7137662796
Practice Fax Number 7122195827
Mailing Address 12828 Willow Centre Dr Ste D
Houston
TX 77066-3043
Mailing Telephone 7137662796
Mailing Fax Number 7122195827
Certification Date 2026-02-13
Enumeration Date 2026-01-06
Last Update Date 2026-02-13
Is Organization Subpart N

Authorized Official Information

Official Name CAROLYN WALDRON
Official Title OWNER
Telephone 7137662796

Taxonomy and Licenses

PrimaryCodeClassificationSpecializationTaxonomy GroupLicense NumberLicense State
Y291U00000XClinical Medical Laboratory

Taxonomy Information

Primary Taxonomy

Code 291U00000X
Taxonomy Clinical Medical Laboratory
Classification Clinical Medical Laboratory
Grouping Laboratories
Definition: (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.
Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186.

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Location Information

Street Address 12828 WILLOW CENTRE DR STE D
City HOUSTON
State TX
Zip Code 77066-3043
Country US

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Provider NameAddressTaxonomyEnumeration Date
Medivo Health Care LLC 12828 Willow Centre Dr Ste D, Houston, TX 77066-3043Durable Medical Equipment & Medical Supplies2026-05-07
Elizabeth K Wills 12828 Willow Centre Dr Ste D, Houston, TX 77066-3043Professional Counselor2015-11-20
The 21 Club of Cny Inc 12828 Willow Centre Dr Ste D, Houston, TX 77066-3043Clinical Medical Laboratory2026-01-06
Lili Smith 12828 Willow Centre Dr Ste D #216, Houston, TX 77066-3043Mental Health Counselor2024-05-27
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Providers in the same zip code

Provider NameAddressTaxonomyEnumeration Date
Medcare Clinics PLLC 12828 Willow Ctr, Suite E, Houston, TX 77066-3043Child & Adolescent Psychiatry Physician2008-01-31
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Dataset Information

This dataset includes over five million health care providers who are assigned National Provider Identifier (NPI) in the National Plan and Provider Enumeration System (NPPES), developed by the Centers for Medicare & Medicaid Services (CMS). Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under Health Insurance Portability and Accountability Act (HIPAA). Each provider is registered with the NPI, full name, status, address, taxonomy, other identifiers, etc.

Subject Transparency and Disclosure
Jurisdiction Federal
Data Provider National Plan and Provider Enumeration System (NPPES), by the Centers for Medicare & Medicaid Services (CMS)
Source download.cms.gov

Dataset Details

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers and all health plans and health care clearinghouses, who must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).

All health care providers who are HIPAA-covered entities, whether individuals or organizations, must get an NPI. A HIPAA-covered entity is a health care provider that conducts certain transactions in electronic form, or a health care clearinghouse, or a health plan (including commercial plans, Medicare, and Medicaid).

Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign unique identifiers to health care providers. The National Provider Indentifier (NPI) has been the standard identifier for all HIPAA-covered entities (health care providers) since May 23, 2007. Small health plans were required to obtain and use an NPI by May 23, 2008.

This dataset includes over five million health care providers (individuals and organizations) who are assigned NPI. The provider data elements are disclosed to the public by the Centers for Medicare & Medicaid Services (CMS) under the Freedom of Information Act (FOIA), as listed in the NPPES Data Dissemination Notice (CMS-6060-N). The NPI final rules define the following elements which required to be disclosed as determined by Department of Health & Human Services (HHS): NPI, Entity Type, Provider Name, Credential, Business Mailing Address, Business Location Address, Healthcare Provider Taxonomy Code, Other Provider Identifier, Provider Enumeration Date, NPI Deactivation Date, Provider License Number, Authorized Official Name and Contact Information.