1669840674 NPI number — IMMUCOR GTI DIAGNOSTICS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669840674 NPI number — IMMUCOR GTI DIAGNOSTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMMUCOR GTI DIAGNOSTICS, 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:
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:
1669840674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 MICHIGAN ST NE STE 574
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49503-3314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-284-3818
Provider Business Mailing Address Fax Number:
616-284-3738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 MICHIGAN ST NE
Provider Second Line Business Practice Location Address:
SUITE 580
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-3314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-284-3818
Provider Business Practice Location Address Fax Number:
616-284-3838
Provider Enumeration Date:
09/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, CHIEF ADMINISTRATIV
Authorized Official Telephone Number:
770-225-8501

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  23D1054909 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 031049 . This is a "STATE LICENSURE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 156426 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100431260 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: COS00800270 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1571 . This is a "STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 23D1054909 . This is a "CLIA CERTIFICATION" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 201131960A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800028023 . This is a "STATE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: L00526 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: LCO00995 . This is a "STATE LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1669840674 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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