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General NPI Number Information
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NPI Number | 1639832355
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Entity Type | Organization
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Legal Business Name | BASELINE DIAGNOSTICS LLC
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 1525 RALEIGH ST STE 300
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City | DENVER
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State | CO
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Zip | 80204-1374
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Country | US
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Telephone | 917-202-2463
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 RALEIGH ST STE 300
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City | DENVER
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State | CO
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Zip | 80204-1374
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Country | US
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Telephone | 917-202-2463
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BENJAMIN SCHWARTZ
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Credential |
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Telephone | 917-202-2463
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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 |
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License Number State |
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