Provider Demographics
NPI:1093756157
Name:NEW SCHRYVER LLC
Entity Type:Organization
Organization Name:NEW SCHRYVER LLC
Other - Org Name:TRIDENTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-786-8015
Mailing Address - Street 1:930 RIDGEBROOK RD FL 3
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9481
Mailing Address - Country:US
Mailing Address - Phone:800-786-8015
Mailing Address - Fax:
Practice Address - Street 1:12075 E 45TH AVE STE 700
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-3123
Practice Address - Country:US
Practice Address - Phone:303-650-5400
Practice Address - Fax:443-842-7264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO02-74852-0000291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12470503Medicaid
CO604940OtherBLUE CROSS
ID1093756157Medicaid
OK200675620BMedicaid
AZ610709Medicaid
NV1093756157Medicaid
UT1002864Medicaid
AL191102Medicaid
OR500605496Medicaid
MS03302593Medicaid
WA2002205Medicaid
AR212862079Medicaid
TX390073001Medicaid
CO690009163OtherRAILROAD MEDICARE
CO19238223Medicaid