1225023005 NPI number — BIOCELLUTIONS, INC

Table of content: (NPI 1225023005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225023005 NPI number — BIOCELLUTIONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOCELLUTIONS, INC
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:
1225023005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1775 MORIAH WOODS BLVD
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38117-7125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-273-0880
Provider Business Mailing Address Fax Number:
901-273-0884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1775 MORIAH WOODS BLVD
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38117-7125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-273-0880
Provider Business Practice Location Address Fax Number:
901-273-0884
Provider Enumeration Date:
09/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAZELTON
Authorized Official First Name:
BONNI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR LABORATORY SERVICES
Authorized Official Telephone Number:
901-273-0880

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  0000002008 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3403201 . This is a "COLL OF AMER PATH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000002008 . This is a "TN DEPT OF HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0126553 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053225 . This is a "FDA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3404106 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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