1225226855 NPI number — NEOGENOMICS LABORATORIES INC

Table of content: (NPI 1225226855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225226855 NPI number — NEOGENOMICS LABORATORIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEOGENOMICS LABORATORIES 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:
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:
1225226855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 865365
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32886-4110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-776-5907
Provider Business Mailing Address Fax Number:
888-443-4153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
618 GRASSMERE PARK
Provider Second Line Business Practice Location Address:
UNIT 20
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-315-5700
Provider Business Practice Location Address Fax Number:
615-574-6094
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHERMAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
866-776-5907

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  0000004061 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 44D1004543 . This is a "CLIA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 017080800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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