1639426281 NPI number — SEQUENOM CENTER FOR MOLECULAR MEDICINE 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 1639426281 NPI number — SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEQUENOM CENTER FOR MOLECULAR MEDICINE 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:
6
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:
1639426281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3595 JOHN HOPKINS CT
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:
92121-1121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-202-9051
Provider Business Mailing Address Fax Number:
858-408-7847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7010 KIT CREEK RD
Provider Second Line Business Practice Location Address:
(PHYSICAL ONLY - NO USPS MAIL DELIVERY)
Provider Business Practice Location Address City Name:
MORRISVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27560-9761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-202-9051
Provider Business Practice Location Address Fax Number:
858-408-7847
Provider Enumeration Date:
08/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VAN DEN BOOM
Authorized Official First Name:
DIRK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
858-202-9051

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  34D2044309 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1639426281 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639426281 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 468862 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00366 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: LCO000772 . This is a "STATE OF RHODE ISLAND, DOH OFFICE OF FACILITIES REGULATION, LAB LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 100263398-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639426281 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34D2044309 . This is a "CLIA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7001489 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: MA102377695-003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 323804001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3910005749 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: COS 00800469 . This is a "STATE OF CALIFORNIA DEPT OF PUBLIC HEALTH, CLINICAL LAB LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 033220 . This is a "STATE OF PENNSYLVANIA, DOH, CLINICAL LAB PERMIT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 853726 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0080201 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06785780 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639426281 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639426281 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200311320 C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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