1275913311 NPI number — REPEAT DIAGNOSTICS INC

Table of content: (NPI 1275913311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275913311 NPI number — REPEAT DIAGNOSTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REPEAT DIAGNOSTICS 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:
1275913311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
267 WEST ESPLANADE AVENUE
Provider Second Line Business Mailing Address:
SUITE 309
Provider Business Mailing Address City Name:
NORTH VANCOUVER
Provider Business Mailing Address State Name:
BC
Provider Business Mailing Address Postal Code:
V7M 1A5
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
604-985-2609
Provider Business Mailing Address Fax Number:
778-340-1144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
267 WEST ESPLANADE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
NORTH VANCOUVER
Provider Business Practice Location Address State Name:
BC
Provider Business Practice Location Address Postal Code:
V7M 1A5
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
604-985-2609
Provider Business Practice Location Address Fax Number:
778-340-1144
Provider Enumeration Date:
06/03/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DE JONG
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/CO-FOUNDER
Authorized Official Telephone Number:
604-985-2609

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  DAP , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: COS 00800307 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 1651 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 94435 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: PFI 8658 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 032302 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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