1275096521 NPI number — SHARP HEALTHCARE

Table of content: (NPI 1275096521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275096521 NPI number — SHARP HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARP HEALTHCARE
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:
SHARP REES STEALY CLINICAL LABORATORY - GENESEE
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:
1275096521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8695 SPECTRUM CENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-1489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-499-3025
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 GENESEE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-616-8400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO SHARP HEALTHCARE
Authorized Official Telephone Number:
858-499-4004

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00354098 . This is a "CLF" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D2167404 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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