=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396790119
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLERMETRIX INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 05/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 SUGARTREE LN SUITE 510
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37064-3079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-599-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 SUGARTREE LN SUITE 510
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37064-3079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-599-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LABORATORY DIRECTOR
-----------------------------------------------------
Name | DR. GARY A KITOS
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 615-587-6651
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | ML0000020883
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------