1598461675 NPI number — ACCUPATH DIAGNOSTIC LABORATORIES, INC

Table of content: (NPI 1598461675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598461675 NPI number — ACCUPATH DIAGNOSTIC LABORATORIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCUPATH DIAGNOSTIC 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:
1598461675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27216-2270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19534 E 54TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80249-8677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-338-2515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2023

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
336-436-5402

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: 06D2273377 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".




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