Provider Demographics
NPI:1326525023
Name:CELLNETIX LABS, LLC
Entity Type:Organization
Organization Name:CELLNETIX LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:KAERSTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-576-6500
Mailing Address - Street 1:1124 COLUMBIA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2048
Mailing Address - Country:US
Mailing Address - Phone:206-576-6500
Mailing Address - Fax:
Practice Address - Street 1:413 LILLY RD NE # DDH06
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5133
Practice Address - Country:US
Practice Address - Phone:206-576-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CELLNETIX LABS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50D2089098291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory