MEDICARE: GALAXY DIAGNOSTICS, 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	34D2027997	NC

General Provider Information

NPI Number	:	1881979888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALAXY DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 14346
Second Line	:	7020 KIT CREEK RD, SUITE 130
City	:	RESEARCH TRIANGLE PARK
State	:	NC
Zip	:	27709-4346
Country	:	US
Telephone Number	:	919-313-9672
Fax Number	:	919-287-2476

Provider Business Practice Location Address
First Line	:	7020 KIT CREEK RD
Second Line	:	SUITE 130
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-9761
Country	:	US
Telephone Number	:	919-313-9672
Fax Number	:	919-287-2476

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AMANDA B. ELAM
Credential	:	PHD
Telephone Number	:	919-313-9672

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	03/02/2015

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