1538576376 NPI number — STEELFUSION CLINICAL TOXICOLOGY LABORATORY, LLC

Table of content: CHARLOTTE SPARKS (NPI 1780410860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538576376 NPI number — STEELFUSION CLINICAL TOXICOLOGY LABORATORY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEELFUSION CLINICAL TOXICOLOGY LABORATORY, 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:
1538576376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1103 DONNER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONESSEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15062-1058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-691-0263
Provider Business Mailing Address Fax Number:
724-420-5783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1103 DONNER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONESSEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15062-1058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-691-0263
Provider Business Practice Location Address Fax Number:
724-420-5783
Provider Enumeration Date:
07/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
REISINGER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-691-0263

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39D2010034 . This is a "CLIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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