=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114163953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TETHYS BIOSCIENCE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2008
-----------------------------------------------------
Last Update Date | 07/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5858 HORTON STREET SUITE 550
-----------------------------------------------------
City | EMERYVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94608-2170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-420-6700
-----------------------------------------------------
Fax | 510-450-0675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5858 HORTON STREET SUITE 550
-----------------------------------------------------
City | EMERYVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94608-2170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-420-6700
-----------------------------------------------------
Fax | 510-450-0675
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR DIRECTOR FINANCE AND ADMINIS
-----------------------------------------------------
Name | GEORGE DEVRIES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-420-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | CLF336670
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------