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General NPI Number Information
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NPI Number | 1750668703
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Entity Type | Organization
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Legal Business Name | EVERIST GENOMICS, INC.
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 709 W ELLSWORTH RD
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City | ANN ARBOR
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State | MI
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Zip | 48108-3371
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Country | US
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Telephone | 734-929-6302
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Fax | 734-929-9501
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Provider Business Mailing Address
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Address Line | 709 W ELLSWORTH RD
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City | ANN ARBOR
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State | MI
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Zip | 48108-3371
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Country | US
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Telephone | 734-929-6302
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Fax | 734-929-9477
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MS. VICKI THEISEN
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Credential |
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Telephone | 734-929-6305
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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 | 23D20178
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License Number State | MI
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