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General NPI Number Information
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NPI Number | 1609826304
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Entity Type | Organization
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Legal Business Name | INTERPACE DIAGNOSTICS CORPORATION
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 2515 LIBERTY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15222-4613
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Country | US
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Telephone | 412-224-6100
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Fax | 412-224-6110
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Provider Business Mailing Address
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Address Line | 2515 LIBERTY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15222-4613
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Country | US
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Telephone | 412-224-6100
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Fax | 412-224-6110
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | THOMAS W BURNELL
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Credential |
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Telephone | 402-613-4184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 39D1024654
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License Number State | PA
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