1619058005 NPI number — CRANSTON/DOTTIN BIOMEDICAL LABORATORY, INC.

Table of content: (NPI 1619058005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619058005 NPI number — CRANSTON/DOTTIN BIOMEDICAL LABORATORY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRANSTON/DOTTIN BIOMEDICAL LABORATORY, 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:
1619058005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1252
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST THOMAS
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00804-1252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-774-6256
Provider Business Mailing Address Fax Number:
340-774-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3004 CONTANT
Provider Second Line Business Practice Location Address:
MEDICAL ARTS COMPLEX #3
Provider Business Practice Location Address City Name:
ST. THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-774-6256
Provider Business Practice Location Address Fax Number:
340-774-1901
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRANSTON
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
LORRAINE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
340-774-6256

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  4419 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30903 . This is a "PIN" identifier . This identifiers is of the category "OTHER".




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