1679580286 NPI number — CYTOMETRY SPECIALISTS, INC.

Table of content: (NPI 1679580286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679580286 NPI number — CYTOMETRY SPECIALISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYTOMETRY SPECIALISTS, 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:
1679580286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2580 WESTSIDE PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30004-8947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-990-9185
Provider Business Mailing Address Fax Number:
678-205-4901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2580 WESTSIDE PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30004-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-990-9185
Provider Business Practice Location Address Fax Number:
678-205-4901
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WICKER
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
678-477-4402

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  060-252 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 009932000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0100102 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36203800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1148261 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00118 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 612093100 . This is a "US DEPARTMENT OF LABOR #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7001178 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2686286 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000765146A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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