1639426281 NPI number — SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC

Table of content: (NPI 1639426281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639426281 NPI number — SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEQUENOM CENTER FOR MOLECULAR MEDICINE 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:
6
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:
1639426281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3595 JOHN HOPKINS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92121-1121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-202-9051
Provider Business Mailing Address Fax Number:
858-408-7847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7010 KIT CREEK RD
Provider Second Line Business Practice Location Address:
(PHYSICAL ONLY - NO USPS MAIL DELIVERY)
Provider Business Practice Location Address City Name:
MORRISVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27560-9761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-202-9051
Provider Business Practice Location Address Fax Number:
858-408-7847
Provider Enumeration Date:
08/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VAN DEN BOOM
Authorized Official First Name:
DIRK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
858-202-9051

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  34D2044309 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1639426281 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639426281 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 468862 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00366 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: LCO000772 . This is a "STATE OF RHODE ISLAND, DOH OFFICE OF FACILITIES REGULATION, LAB LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 100263398-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639426281 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34D2044309 . This is a "CLIA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7001489 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: MA102377695-003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 323804001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3910005749 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: COS 00800469 . This is a "STATE OF CALIFORNIA DEPT OF PUBLIC HEALTH, CLINICAL LAB LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 033220 . This is a "STATE OF PENNSYLVANIA, DOH, CLINICAL LAB PERMIT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 853726 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0080201 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06785780 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639426281 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639426281 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200311320 C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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