Healthcare Provider Details

I. General information

NPI: 1265671515
Provider Name (Legal Business Name): NORDX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301A US ROUTE 1 FINANCE DEPT RE: HLA LAB
SCARBOROUGH ME
04074-9701
US

IV. Provider business mailing address

301A US ROUTE 1 FINANCE DEPT RE: HLA LAB
SCARBOROUGH ME
04074-9701
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-7812
  • Fax: 207-396-7880
Mailing address:
  • Phone: 207-396-7812
  • Fax: 207-396-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number20D0911771
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberMEDLC 001
License Number StateME

VIII. Authorized Official

Name: JAMES D MCAVOY
Title or Position: CFO
Credential:
Phone: 207-396-7812