Mentorup Life Lab & Clinic
NPI 1063104511ActiveOrganization· General Practice· Tuscaloosa, AL
General Practice in Tuscaloosa, Alabama, registered in NPPES in May 2023. The authorized official on file is Ellory Kate Johnson, MD, Medical Director.
Overview
| NPI | 1063104511 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 23, 2023 |
| Last updated in NPPES | May 23, 2023 |
| Certified by provider | May 23, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| General Practice Primary | 208D00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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