1730481078 NPI number — SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC

Table of content: (NPI 1730481078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730481078 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:
SEQUENOM LABORATORIES
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:
1730481078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2017
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:
3595 JOHN HOPKINS CT
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:
92121-1121
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:
11/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
800-222-7566

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF00339964 , 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: 003115419A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05D2015356 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1020915 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102377695-002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1728 . This is a "MARYLAND MEDICAL LABORATORY PERMIT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1730481078 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730481078 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800026127 . This is a "STATE OF FLORIDA CLINICAL LABORATORY LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1527595 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730481078 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200311320B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2017818 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2192639 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100190660 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7527138 . This is a "COLLEGE OF AMERICAN PATHOLOGISTS (CAP)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 770365889-002 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92038026 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00343 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 032136 . This is a "STATE OF PENNSYLVANIA CLINICAL LABORATORY LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1730481078 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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