Healthcare Provider Details

I. General information

NPI: 1982984084
Provider Name (Legal Business Name): NEW SCHRYVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17744 NE SAN RAFAEL ST
GRESHAM OR
97230-5927
US

IV. Provider business mailing address

12075 E 45TH AVE SUITE 600
DENVER CO
80239-3123
US

V. Phone/Fax

Practice location:
  • Phone: 303-371-0073
  • Fax: 303-785-9283
Mailing address:
  • Phone: 303-371-0073
  • Fax: 303-785-9283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHAWNA FLETCHER
Title or Position: PROVIDER RELATIONS COORDINATOR
Credential:
Phone: 303-307-2081