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NPI Code Detail

MEDICARE: BASIS DIAGNOSTICS INC.

MEDICARE: BASIS 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
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11922113331OTHERCANPI

General Provider Information

NPI Number : 1942891312
Entity Type Code : Organization
Provider Name (Legal Business Name) : BASIS DIAGNOSTICS INC.
Provider Business Mailing Address
First Line : 2688 MIDDLEFIELD RD STE A
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-3483
Country : US
Telephone Number : 855-920-4522
Fax Number :
Provider Business Practice Location Address
First Line : 2688 MIDDLEFIELD RD STE A
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-3483
Country : US
Telephone Number : 855-920-4522
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. ANDREAS MATTHIAS KOGELNIK
Credential : MD
Telephone Number : 650-776-4703
Provider Enumeration Date : 01/28/2021
Last Update Date : 01/23/2024

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