1952777831 NPI number — QUASAR ANALYTICAL LABORATORIES, LLC

Table of content: (NPI 1952777831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952777831 NPI number — QUASAR ANALYTICAL LABORATORIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUASAR ANALYTICAL 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:
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:
1952777831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4419 CENTENNIAL BLVD
Provider Second Line Business Mailing Address:
PMB STE 250
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80907-3739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-309-6270
Provider Business Mailing Address Fax Number:
719-574-2404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4835 CENTENNIAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80919-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-309-6270
Provider Business Practice Location Address Fax Number:
719-574-2404
Provider Enumeration Date:
08/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KEPHART
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
719-418-5210

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  06D2108666 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com