Provider Demographics
NPI:1235455338
Name:CEDAR DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:CEDAR DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ATHANASSIOS
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAPAIOANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-916-3200
Mailing Address - Street 1:658 GRASSMERE PARK STE 104
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3683
Mailing Address - Country:US
Mailing Address - Phone:615-916-3200
Mailing Address - Fax:
Practice Address - Street 1:555 RIVERGATE STE B2-136
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7480
Practice Address - Country:US
Practice Address - Phone:970-247-0937
Practice Address - Fax:970-247-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06D1065912291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06D1065912OtherCLIA
CO35532084Medicaid