Provider Demographics
NPI:1326495169
Name:BIRTH TISSUE RECOVERY
Entity Type:Organization
Organization Name:BIRTH TISSUE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MBA
Authorized Official - Phone:336-705-0250
Mailing Address - Street 1:751 BETHESDA RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3300
Mailing Address - Country:US
Mailing Address - Phone:336-448-1910
Mailing Address - Fax:336-448-1911
Practice Address - Street 1:751 BETHESDA RD
Practice Address - Street 2:SUITE D
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3300
Practice Address - Country:US
Practice Address - Phone:336-448-1910
Practice Address - Fax:336-448-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332G00000XSuppliersEye Bank