Provider Demographics
NPI:1083264543
Name:PARADIGM WEST LLC
Entity Type:Organization
Organization Name:PARADIGM WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-222-2804
Mailing Address - Street 1:249 REDFERN VLG
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2536
Mailing Address - Country:US
Mailing Address - Phone:912-342-2443
Mailing Address - Fax:912-342-2446
Practice Address - Street 1:2110 RESEARCH ROW STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2520
Practice Address - Country:US
Practice Address - Phone:912-342-2443
Practice Address - Fax:912-342-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory