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General NPI Number Information
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NPI Number | 1912903717
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Entity Type | Organization
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Legal Business Name | DOMINION DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 211 CIRCUIT DRIVE
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-7440
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Country | US
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Telephone | 877-734-9600
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Fax | 401-667-0330
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Provider Business Mailing Address
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Address Line | 211 CIRCUIT DRIVE
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-7440
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Country | US
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Telephone | 877-734-9600
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Fax | 401-667-0330
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Authorized Official
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Title or Position | PAYER RELATIONS REP
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Name | BRANDY ELLIS
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Credential |
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Telephone | 802-734-6392
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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 | 00343
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License Number State | RI
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