1073591822 NPI number — GENOVA DIAGNOSTICS INC

Table of content: (NPI 1073591822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073591822 NPI number — GENOVA DIAGNOSTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENOVA DIAGNOSTICS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GREAT SMOKIES DIAGNOSTIC LABORATORY
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073591822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 ZILLICOA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28801-1038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-540-2199
Provider Business Mailing Address Fax Number:
828-210-7321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 ZILLICOA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-1038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-210-7321
Provider Business Practice Location Address Fax Number:
828-210-7321
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEDFORD
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
828-210-7764

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  34D0655571 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8900489 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4490659 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 543317700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: I54653 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016210100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com