Healthcare Provider Details

I. General information

NPI: 1265196471
Provider Name (Legal Business Name): SEMA4 OPCO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 1ST ST
WINSTON SALEM NC
27101-4165
US

IV. Provider business mailing address

333 LUDLOW STREET 8TH FLOOR, NORTH TOWER
STAMFORD CT
06902
US

V. Phone/Fax

Practice location:
  • Phone: 800-298-6470
  • Fax:
Mailing address:
  • Phone: 800-298-6470
  • 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: ERIC COHEN
Title or Position: VP MANAGED CARE
Credential:
Phone: 800-298-6470