1306867981 NPI number — BIOMEDICAL LABORATORIES

Table of content: (NPI 1306867981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306867981 NPI number — BIOMEDICAL LABORATORIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOMEDICAL LABORATORIES
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:
BIOMEDICAL LABORATORIES
Provider Other Organization Name Type Code:
3
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:
1306867981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
480 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02135-2655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-783-0600
Provider Business Mailing Address Fax Number:
617-783-0602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-783-0600
Provider Business Practice Location Address Fax Number:
617-783-0602
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PILLAI
Authorized Official First Name:
APPU
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
617-783-0600

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  2427 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 701421 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9724627 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11470212 . This is a "CAQH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0802344 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 228400 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008779 . This is a "CHILDREN'S MEDICAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 800345 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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