1598728107 NPI number — HARRIS HISTOLOGY RELIEF SERVICES INC

Table of content: (NPI 1598728107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598728107 NPI number — HARRIS HISTOLOGY RELIEF SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRIS HISTOLOGY RELIEF SERVICES 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:
1598728107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2025 EASTGATE DR
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27858-4154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-830-6866
Provider Business Mailing Address Fax Number:
252-830-0032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 EASTGATE DR
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27858-4154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-830-6866
Provider Business Practice Location Address Fax Number:
252-830-0032
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TROYER
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT, CEO
Authorized Official Telephone Number:
252-830-6866

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: 7001138 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34D0882748 . This is a "CLIA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 690007364 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 01952 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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