MEDICARE: OMNISEQ, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	33D2098748	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33D2098748	OTHER		CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184098063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNISEQ, INC.

Provider Business Mailing Address
First Line	:	700 ELLICOTT ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14203-1102
Country	:	US
Telephone Number	:	716-898-8661
Fax Number	:	716-898-8602

Provider Business Practice Location Address
First Line	:	700 ELLICOTT ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14203-1102
Country	:	US
Telephone Number	:	716-898-8591
Fax Number	:	716-898-8602

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KIMBERLY T WILLIAMS
Credential	:
Telephone Number	:	336-436-5402

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	03/15/2022

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Directions to “OMNISEQ, INC. ” Practice Location

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