1487830733 NPI number — CELLIGENT DIAGNOSTICS, LLC

Table of content: (NPI 1487830733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487830733 NPI number — CELLIGENT DIAGNOSTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CELLIGENT DIAGNOSTICS, LLC
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:
1487830733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 63321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28263-3321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-973-5500
Provider Business Mailing Address Fax Number:
704-973-5518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6135 LAKEVIEW RD STE 350
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28269-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-549-8884
Provider Business Practice Location Address Fax Number:
704-549-0559
Provider Enumeration Date:
01/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-973-5500

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q608360001 . This is a "MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 7001318 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPA737 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".