1538755376 NPI number — ASAP LABS AND CARE, LLC

Table of content: (NPI 1538755376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538755376 NPI number — ASAP LABS AND CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASAP LABS AND CARE, 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:
1538755376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2002 NEW GARDEN RD UNIT 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27410-2562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-564-6400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 NEW GARDEN RD UNIT 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27410-2562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-564-6400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MERCER
Authorized Official First Name:
BRITTANY
Authorized Official Middle Name:
SELLICKA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-386-1723

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207KA0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207KI0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X ; 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: 34D2205647 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1538755376 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".