Healthcare Provider Details

I. General information

NPI: 1225034739
Provider Name (Legal Business Name): DYNACARE NORTHWEST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E DAVIS ST
BURLINGTON NC
27215-5816
US

IV. Provider business mailing address

PO BOX 2240
BURLINGTON NC
27216-2240
US

V. Phone/Fax

Practice location:
  • Phone: 800-222-7566
  • Fax:
Mailing address:
  • Phone: 800-222-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. BRADFORD T SMITH
Title or Position: PRESIDENT
Credential:
Phone: 800-222-7566