1780308262 NPI number — CIRCULOGENE THERANOSTICS, INC.

Table of content: (NPI 1780308262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780308262 NPI number — CIRCULOGENE THERANOSTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CIRCULOGENE THERANOSTICS, 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:
1780308262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 830525
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35283-0525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-614-7083
Provider Business Mailing Address Fax Number:
855-614-7084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 E GARDEN ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32502-4806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-614-7083
Provider Business Practice Location Address Fax Number:
855-614-7084
Provider Enumeration Date:
09/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MULLEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
855-614-7083

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: 19070 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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