MEDICARE: INTERPACE DIAGNOSTICS CORPORATION

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	39D1024654	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	001686800	OTHER	PA	HIGHMARK BS

General Provider Information

NPI Number	:	1609826304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERPACE DIAGNOSTICS CORPORATION

Provider Business Mailing Address
First Line	:	2515 LIBERTY AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15222-4613
Country	:	US
Telephone Number	:	412-224-6100
Fax Number	:	412-224-6110

Provider Business Practice Location Address
First Line	:	2515 LIBERTY AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15222-4613
Country	:	US
Telephone Number	:	412-224-6100
Fax Number	:	412-224-6110

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	THOMAS W BURNELL
Credential	:
Telephone Number	:	402-613-4184

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	06/29/2021

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Directions to “INTERPACE DIAGNOSTICS CORPORATION ” Practice Location

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