1598760035 NPI number — COMPUNET CLINICAL LABORATORIES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598760035 NPI number — COMPUNET CLINICAL LABORATORIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPUNET CLINICAL LABORATORIES 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:
COMPUNET CLINICAL LABORATORIES LTD
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:
1598760035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2308 SANDRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORAINE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-296-0844
Provider Business Mailing Address Fax Number:
937-297-8232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3737 SOUTHERN BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 3200
Provider Business Practice Location Address City Name:
KETTERING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45429-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-297-8253
Provider Business Practice Location Address Fax Number:
937-297-8229
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MANIER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO/VP FINANCE
Authorized Official Telephone Number:
937-297-8202

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  36D0698030 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 690002971 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2427369 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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