1003810375 NPI number — SPECTRA LABORATORIES INC

Table of content: (NPI 1003810375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003810375 NPI number — SPECTRA LABORATORIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRA LABORATORIES 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:
Provider Other Organization Name Type Code:
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:
1003810375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILPITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95036-0790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-526-3200
Provider Business Mailing Address Fax Number:
408-526-3747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 SYCAMORE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILPITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95035-7429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-526-3200
Provider Business Practice Location Address Fax Number:
408-526-3747
Provider Enumeration Date:
06/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER VP OPERATIONS
Authorized Official Telephone Number:
408-526-3200

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF3259 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ59406Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98001761 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003099018 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 090418000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 067703 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000594060 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00305247A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0034655 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0441970 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117941709 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: LB259CA , issued by the state of ( AS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 090418000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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