1740534023 NPI number — CLINICAL CYTOGENETIC SERVICES

Table of content: (NPI 1740534023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740534023 NPI number — CLINICAL CYTOGENETIC SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL CYTOGENETIC SERVICES
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:
1740534023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1928 ALCOA HWY
Provider Second Line Business Mailing Address:
SUITE B-206
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37920-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-305-6505
Provider Business Mailing Address Fax Number:
865-305-6516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1928 ALCOA HWY
Provider Second Line Business Practice Location Address:
SUITE B-206
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-305-6505
Provider Business Practice Location Address Fax Number:
865-305-6516
Provider Enumeration Date:
11/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LOZZIO
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
865-305-6505

Provider Taxonomy Codes

  • Taxonomy code: 207SG0201X , with the licence number:  MD0000009071 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3181311 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003962002 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".




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